Healthcare Provider Details

I. General information

NPI: 1396718078
Provider Name (Legal Business Name): LAURIE A OHLMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FLOOR 3
BOSTON MA
02115-5711
US

IV. Provider business mailing address

15 BEECHWOOD RD
WELLESLEY MA
02482-2316
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6417
  • Fax:
Mailing address:
  • Phone: 781-237-7794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number73546
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: