Healthcare Provider Details

I. General information

NPI: 1184618043
Provider Name (Legal Business Name): LAURA J MARBURGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BELLEMEADE AVE STE 117
EVANSVILLE IN
47714-0102
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-7254
  • Fax: 812-485-7225
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01045233
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: