Healthcare Provider Details

I. General information

NPI: 1154137578
Provider Name (Legal Business Name): MICAH LAUFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DAVIS STRAITS
FALMOUTH MA
02540-3906
US

IV. Provider business mailing address

204 WAREHAM RD APT 10113
PLYMOUTH MA
02360-2587
US

V. Phone/Fax

Practice location:
  • Phone: 774-255-3010
  • Fax:
Mailing address:
  • Phone: 919-467-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101620
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: