Provider Demographics
NPI:1548326689
Name:RASENAS, LEONIDA LUCINDA (MD)
Entity type:Individual
Prefix:
First Name:LEONIDA
Middle Name:LUCINDA
Last Name:RASENAS
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 1:23 WARREN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4979
Mailing Address - Country:US
Mailing Address - Phone:781-933-0710
Mailing Address - Fax:781-937-3947
Practice Address - Street 1:23 WARREN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4979
Practice Address - Country:US
Practice Address - Phone:781-933-0710
Practice Address - Fax:781-937-3947
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA55855207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3047547Medicaid
MA3047547Medicaid
MAJ08832Medicare PIN