Healthcare Provider Details

I. General information

NPI: 1336182997
Provider Name (Legal Business Name): LAURI ANN MAITLAND DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MEMORIAL AVE
LYNCHBURG VA
24501-2661
US

IV. Provider business mailing address

136 BEACON HILL PL UNIT 2
LYNCHBURG VA
24503-4128
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5200
  • Fax:
Mailing address:
  • Phone: 603-748-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12309
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102204809
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: