Most Relevant Information
Provider Data
| NPI Number: | 1003226226 |
| Provider Name: | LARA EISA M.D |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/28/2014 |
| Last Updated: | 08/23/2019 |
Provider Practice Location
3435 MAIN ST
252 FARBER HALL
BUFFALO
NY
142143001
Practice Location Phone/Fax
| Phone: | 7168296102 |
| Fax: |
Provider Mailing Location
25 MORRISSEY BLVD UNIT 1130
DORCHESTER
MA
021253354
Provider Mailing Phone/Fax
| Phone: | 7163648535 |
| Fax: |