1184618043 NPI number — DR. LAURA J MARBURGER MD

Table of content: DR. LAURA J MARBURGER MD (NPI 1184618043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184618043 NPI number — DR. LAURA J MARBURGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARBURGER
Provider First Name:
LAURA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184618043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-6815
Provider Business Mailing Address Fax Number:
812-450-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 BELLEMEADE AVE
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-0102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-485-7254
Provider Business Practice Location Address Fax Number:
812-485-7225
Provider Enumeration Date:
09/07/2005

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:  01045233 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276096 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200120260C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000349624 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com