Healthcare Provider Details

I. General information

NPI: 1144710575
Provider Name (Legal Business Name): LAURA LEE PEDERSEN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

1000 E MARSHALL ST # 980049
RICHMOND VA
23298-1900
US

V. Phone/Fax

Practice location:
  • Phone: 48-828-9711
  • Fax: 804-828-3097
Mailing address:
  • Phone: 804-828-9711
  • Fax: 804-828-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101281284
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: