1497855654 NPI number — DR. LAURIE LAZAR MIDGETTE AU.D.

Table of content: DR. LAURIE LAZAR MIDGETTE AU.D. (NPI 1497855654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497855654 NPI number — DR. LAURIE LAZAR MIDGETTE AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIDGETTE
Provider First Name:
LAURIE
Provider Middle Name:
LAZAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
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:
1497855654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
337 WINDSOR PARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-574-8465
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 ELWYN RD
Provider Second Line Business Practice Location Address:
YAGO BUILDING, B1
Provider Business Practice Location Address City Name:
ELWYN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-891-2209
Provider Business Practice Location Address Fax Number:
610-891-7000
Provider Enumeration Date:
09/25/2006

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: 231H00000X , with the licence number:  AT000208L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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