Provider Demographics
NPI:1366431785
Name:LASSER, JOAN L (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:LASSER
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 1:20 CATAMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1204
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-432-2457
Practice Address - Street 1:20 CATAMORE BLVD
Practice Address - Street 2:RHODE ISLAND MEDICAL IMAGING
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1204
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-432-2457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI54232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
005423OtherBLUESHIELD
005423OtherTUFTS
1600025OtherUNITEDHEALTHPLANS
3200396OtherMASSMEDICAID
241366OtherPIHPILGRIM
000000001988OtherNHPRI
002516OtherBLUECHIP
3200396OtherHEALTHYSTART
JL01240OtherRIMEDICALASSITANCE
005423OtherTUFTS