Healthcare Provider Details

I. General information

NPI: 1609860998
Provider Name (Legal Business Name): LAURA R CORDES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD STE 110
NEWPORT NEWS VA
23606-4430
US

IV. Provider business mailing address

860 OMNI BLVD STE 101
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-223-9794
  • Fax: 757-223-9168
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101235476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: