Provider Demographics
NPI:1144655416
Name:TOMSOVIC, LAILA CLAIRE (ND)
Entity type:Individual
Prefix:DR
First Name:LAILA
Middle Name:CLAIRE
Last Name:TOMSOVIC
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 CIDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:HAYDENVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01039-9700
Mailing Address - Country:US
Mailing Address - Phone:413-655-1505
Mailing Address - Fax:888-971-7217
Practice Address - Street 1:63 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6093
Practice Address - Country:US
Practice Address - Phone:802-246-4282
Practice Address - Fax:888-971-7217
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0088763175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022342Medicaid