Healthcare Provider Details

I. General information

NPI: 1013993070
Provider Name (Legal Business Name): LAURA B. SOLLENBERGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NASON DRIVE
ROARING SPRING PA
16673
US

IV. Provider business mailing address

PO BOX 6
NEW ENTERPRISE PA
16664-0006
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-5132
  • Fax:
Mailing address:
  • Phone: 814-244-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD042235L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: