Healthcare Provider Details

I. General information

NPI: 1629040084
Provider Name (Legal Business Name): LAURA S PICCIANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 MAIN STREET THE RIPA CENTER
VOORHEES NJ
08043-4660
US

IV. Provider business mailing address

100 E. LANCASTER AVE. SUITE 330 MOB WEST
WYNNEWOOD PA
19096-3443
US

V. Phone/Fax

Practice location:
  • Phone: 856-673-4912
  • Fax: 856-938-2077
Mailing address:
  • Phone: 610-645-6555
  • Fax: 610-649-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS009621L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB07361900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: