Healthcare Provider Details

I. General information

NPI: 1821402918
Provider Name (Legal Business Name): LAURA CHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA WONG M.D.

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE RM 588
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0942
  • Fax: 410-550-0443
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD88008
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: