Healthcare Provider Details

I. General information

NPI: 1265795306
Provider Name (Legal Business Name): LAURA HOLMES O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2270
US

IV. Provider business mailing address

6801 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2270
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-9471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1265795306
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.143964
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125061493
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: