Healthcare Provider Details

I. General information

NPI: 1639150758
Provider Name (Legal Business Name): LAURIE TYAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LILY POND CT
ROCKVILLE MD
20852-4230
US

IV. Provider business mailing address

18 LILY POND CT
ROCKVILLE MD
20852-4230
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-9101
  • Fax:
Mailing address:
  • Phone: 240-476-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0044719
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: