Healthcare Provider Details

I. General information

NPI: 1548218373
Provider Name (Legal Business Name): MARY RACHEL LAIRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST #3593
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1400 E BOULDER ST #3593
COLORADO SPRINGS CO
80909-5533
US

V. Phone/Fax

Practice location:
  • Phone: 719-447-8812
  • Fax: 719-447-8987
Mailing address:
  • Phone: 719-447-8812
  • Fax: 719-447-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35846
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: