Healthcare Provider Details

I. General information

NPI: 1598740714
Provider Name (Legal Business Name): LAURA A BORTHWICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 FITZWATERTOWN RD SUITE 4
WILLOW GROVE PA
19090-1338
US

IV. Provider business mailing address

735 FITZWATERTOWN RD SUITE 4
WILLOW GROVE PA
19090-1338
US

V. Phone/Fax

Practice location:
  • Phone: 215-914-4400
  • Fax: 215-657-4887
Mailing address:
  • Phone: 215-914-4400
  • Fax: 215-657-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD072216L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: