MEDICARE: LAURA BARISONI-THOMAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician	223489	NY
2	207ZP0101X	Anatomic Pathology Physician	ME112329	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063405793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BARISONI-THOMAS M.D.

Provider Business Mailing Address
First Line	:	1611 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1005
Country	:	US
Telephone Number	:	305-585-6303
Fax Number	:	305-326-6306

Provider Business Practice Location Address
First Line	:	40 DUKE MEDICINE CIR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-1005
Country	:	US
Telephone Number	:	919-681-0708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	12/21/2018

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