Healthcare Provider Details

I. General information

NPI: 1386664902
Provider Name (Legal Business Name): LAURIE B BRIGANDI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE A PORTER D.O.

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 GREENVIEW DR STE 385
STATE COLLEGE PA
16803-2106
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-466-6396
  • Fax: 814-466-6056
Mailing address:
  • Phone: 814-231-7100
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number13178
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS014586
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberH0071533
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: