Healthcare Provider Details

I. General information

NPI: 1902860737
Provider Name (Legal Business Name): LAURA N. PERSHOUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2672 SUNNYFIELD DR
UPPER ST CLAIR PA
15241-2510
US

IV. Provider business mailing address

2672 SUNNYFIELD DR
UPPER ST CLAIR PA
15241-2510
US

V. Phone/Fax

Practice location:
  • Phone: 972-955-8932
  • Fax:
Mailing address:
  • Phone: 972-955-8932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD441212
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: