Provider Demographics
NPI:1679572390
Name:LASSON, NANCY C (DO)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:LASSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:PRC AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:1195 NORTH MAIN STREET
Practice Address - Street 2:CNEMG PRIMARY CARE WMC
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-0288
Practice Address - Country:US
Practice Address - Phone:401-736-4562
Practice Address - Fax:401-921-9864
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000541603Medicaid
F66624Medicare UPIN
DE0000541603Medicaid