Healthcare Provider Details

I. General information

NPI: 1174520506
Provider Name (Legal Business Name): LAUREL PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WAYLAND SMITH DRIVE
UNIONTOWN PA
15401
US

IV. Provider business mailing address

140 WAYLAND SMITH DRIVE
UNIONTOWN PA
15401
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-9854
  • Fax: 724-437-8305
Mailing address:
  • Phone: 724-437-9854
  • Fax: 724-437-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier26039
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. LOIS J PETRAZZI
Title or Position: OFFICE MANAGER ADMINISTRATOR
Credential:
Phone: 724-437-9854