Healthcare Provider Details

I. General information

NPI: 1700040946
Provider Name (Legal Business Name): LAURA LONDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 KNIGHTSBRIDGE BLVD STE E
COLUMBUS OH
43214-2300
US

IV. Provider business mailing address

4830 KNIGHTSBRIDGE BLVD STE E
COLUMBUS OH
43214-4339
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-2280
  • Fax: 614-451-4229
Mailing address:
  • Phone: 614-451-2280
  • Fax: 614-451-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35.125575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: