Healthcare Provider Details

I. General information

NPI: 1467564146
Provider Name (Legal Business Name): LAURA PAXTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/23/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PRESIDENTIAL PLAZA 2ND FLOOR
SYRACUSE NY
13202
US

IV. Provider business mailing address

90 PRESIDENTIAL PLAZA 2ND FLOOR
SYRACUSE NY
13202
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3836
  • Fax:
Mailing address:
  • Phone: 315-464-3836
  • Fax: 315-464-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number247462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: