Healthcare Provider Details

I. General information

NPI: 1063405793
Provider Name (Legal Business Name): LAURA BARISONI-THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA BARISONI M.D.

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DUKE MEDICINE CIR
DURHAM NC
27710-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-0708
  • Fax:
Mailing address:
  • Phone: 305-585-6303
  • Fax: 305-326-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number223489
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME112329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: