=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376957563
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA CORSINI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2014
-----------------------------------------------------
Last Update Date | 07/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 N BEAUREGARD ST STE 110
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22311-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-447-1813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 744 LANCASTER AVE STE 230
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19087-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-688-8750
-----------------------------------------------------
Fax | 610-688-8751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | MD478646
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 0101265201
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------