Healthcare Provider Details

I. General information

NPI: 1780334896
Provider Name (Legal Business Name): LAURA BUCHWALDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDREN'S LANE
NORFOLK VA
23507-9982
US

IV. Provider business mailing address

2567 OLDE HILL CT S
COLUMBUS OH
43221-3634
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7249
  • Fax:
Mailing address:
  • Phone: 937-371-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: