Healthcare Provider Details

I. General information

NPI: 1548760903
Provider Name (Legal Business Name): LAURA MARGARET MACCARALD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ARROWOOD DR
ITHACA NY
14850-1869
US

IV. Provider business mailing address

5040 WILLIAMEE RD
TRUMANSBURG NY
14886-9617
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-7800
  • Fax:
Mailing address:
  • Phone: 607-229-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: