Healthcare Provider Details

I. General information

NPI: 1942275763
Provider Name (Legal Business Name): LAURA BAALMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA K BAALMANN-MANGANO MD

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD DEPARTMENT OF PATHOLOGY
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

PO BOX 500720
SAINT LOUIS MO
63150-0720
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4285
  • Fax: 314-996-5551
Mailing address:
  • Phone: 314-989-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2002015959
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: