Healthcare Provider Details

I. General information

NPI: 1811208986
Provider Name (Legal Business Name): LAURA ELIZABETH KORPON MHS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH ANDERSON MHS, PA-C

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY WAYSON PAVILION, SUITE 301
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

2003 MEDICAL PKWY WAYSON PAVILION, SUITE 301
ANNAPOLIS MD
21401-7992
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-3300
  • Fax:
Mailing address:
  • Phone: 443-481-6538
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: