Healthcare Provider Details

I. General information

NPI: 1093800757
Provider Name (Legal Business Name): LAURA K AISENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15769 WC MAIN ST
MIDLOTHIAN VA
23113-7327
US

IV. Provider business mailing address

15769 WC MAIN ST
MIDLOTHIAN VA
23113-7327
US

V. Phone/Fax

Practice location:
  • Phone: 804-419-9760
  • Fax: 804-378-9140
Mailing address:
  • Phone: 804-419-9760
  • Fax: 804-378-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101235342
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: