1053635011 NPI number — LAURA D PHILLIPS-CHOU MD

Table of content: LAURA D PHILLIPS-CHOU MD (NPI 1053635011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053635011 NPI number — LAURA D PHILLIPS-CHOU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS-CHOU
Provider First Name:
LAURA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHILLIPS-CHOU
Provider Other First Name:
LAURA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053635011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6503 E BROAD ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43213-1692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-434-5437
Provider Business Mailing Address Fax Number:
614-454-5438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6503 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213-1692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-434-5437
Provider Business Practice Location Address Fax Number:
614-454-5438
Provider Enumeration Date:
03/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35.098559 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0084872 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".