Provider Demographics
NPI:1811096340
Name:RUSIN, LAWRENCE C (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:RUSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC, INC.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:781-744-5215
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY CLINIC, INC.
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8000
Practice Address - Fax:781-744-5215
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80421208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110058187AMedicaid
MAB33426Medicare UPIN
MAJ3101601Medicare PIN