Healthcare Provider Details

I. General information

NPI: 1629114657
Provider Name (Legal Business Name): LAURIE J. POSS, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 DEFENSE HIGHWAY SUITE 211
ANNAPOLIS MD
21401-7378
US

IV. Provider business mailing address

133 DEFENSE HIGHWAY SUITE 211
ANNAPOLIS MD
21401-7378
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-0904
  • Fax: 410-571-0905
Mailing address:
  • Phone: 410-571-0904
  • Fax: 410-571-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD00032567
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberD0032567
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0032567
License Number StateMD

VIII. Authorized Official

Name: LAURIE JANE POSS
Title or Position: OWNER
Credential: M.D.
Phone: 410-571-0904