Provider Demographics
NPI:1922022649
Name:RICHARDSON, LARS CARVER (MD)
Entity type:Individual
Prefix:DR
First Name:LARS
Middle Name:CARVER
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1101 BEACON STREET
Mailing Address - Street 2:SUITE 5W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-232-2663
Mailing Address - Fax:617-232-6342
Practice Address - Street 1:1101 BEACON STREET
Practice Address - Street 2:SUITE 5W
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-232-2663
Practice Address - Fax:617-232-6342
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204502174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA204502OtherTUFTS
MA5523775002OtherCIGNA
MA380493OtherHEALTH SOURCE
MAJ22212OtherBLUE CROSS/BLUE SHIELD
MA172792OtherHARVARD PILGRIM
MA3206629Medicaid
MA7585085OtherAETNA
MA204502OtherTUFTS
MA172792OtherHARVARD PILGRIM