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General NPI Number Information
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NPI Number | 1407802697
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Entity Type | Individual
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Provider Name | WILLIAM L LAURY SR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 834 E UPSAL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1541
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Country | US
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Telephone | 215-924-4440
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Fax | 215-927-4777
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Provider Business Mailing Address
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Address Line | 175 W COHAWKIN RD STE C
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City | CLARKSBORO
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State | NJ
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Zip | 08020-1145
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Country | US
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Telephone | 856-423-7700
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Fax | 856-423-0823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD016761E
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License Number State | PA
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