Provider Demographics
NPI:1588769509
Name:LACOMIS, ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:LACOMIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MALT LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7031
Mailing Address - Country:US
Mailing Address - Phone:781-416-3500
Mailing Address - Fax:781-416-3505
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-416-3500
Practice Address - Fax:781-416-3505
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160915174400000X, 207N00000X
NH10651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA29664Medicare ID - Type Unspecified
G94527Medicare UPIN