Provider Demographics
NPI:1871526855
Name:LANDA, RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:LANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:122 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1118
Mailing Address - Country:US
Mailing Address - Phone:508-839-5551
Mailing Address - Fax:508-839-9696
Practice Address - Street 1:85 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8200
Practice Address - Country:US
Practice Address - Phone:508-383-1544
Practice Address - Fax:508-879-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA745632086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724681Medicaid
MA9724681Medicaid
MAJ12490Medicare ID - Type Unspecified