Healthcare Provider Details

I. General information

NPI: 1871138479
Provider Name (Legal Business Name): LAURA ANN MCCAGUE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MEADOW DR STE A
MOUNT GILEAD OH
43338-1063
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 567-876-6360
  • Fax: 614-533-1442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006172RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: