Healthcare Provider Details

I. General information

NPI: 1679839641
Provider Name (Legal Business Name): LAURA HIGGINBOTHAM MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE AVE
SILVER SPRING MD
20903-1058
US

IV. Provider business mailing address

1550 7TH ST NW APT 414
WASHINGTON DC
20001-3265
US

V. Phone/Fax

Practice location:
  • Phone: 240-302-0261
  • Fax:
Mailing address:
  • Phone: 540-319-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101264473
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: