Healthcare Provider Details

I. General information

NPI: 1669978136
Provider Name (Legal Business Name): LAURA M BARBOUR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE STE 201
FREDERICK MD
21702-5126
US

IV. Provider business mailing address

1475 TANEY AVE STE 201
FREDERICK MD
21702-5126
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0133
  • Fax:
Mailing address:
  • Phone: 301-662-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH91234
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: