Healthcare Provider Details

I. General information

NPI: 1427051507
Provider Name (Legal Business Name): LAURA S EMMICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LAURA ISABELLE SMITH

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 FOGG CT
MANCHESTER NH
03104-4103
US

IV. Provider business mailing address

27 FOGG CT
MANCHESTER NH
03104-4103
US

V. Phone/Fax

Practice location:
  • Phone: 603-232-2704
  • Fax:
Mailing address:
  • Phone: 603-232-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11693
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11693
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: