Healthcare Provider Details

I. General information

NPI: 1053815910
Provider Name (Legal Business Name): ASHLEY LAURA MALARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LAURA GELINAS MD

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114C MEMORIAL DR
JACKSONVILLE NC
28546-6328
US

IV. Provider business mailing address

PO BOX 986513 DEPARTMENT 100
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-9688
  • Fax: 910-353-7498
Mailing address:
  • Phone: 910-219-8326
  • Fax: 910-939-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202101924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: