MEDICARE: MICHELE RENEE LAURIA MD, MS

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	MD20782	ME
2	207VM0101X	Maternal & Fetal Medicine Physician	10213	NH
3	207VM0101X	Maternal & Fetal Medicine Physician	186886-1	NY

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

NPI Number	:	1316960057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE RENEE LAURIA MD, MS

Provider Business Mailing Address
First Line	:	15 ARGYLE PARK
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-1205
Country	:	US
Telephone Number	:	603-340-3644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MAIN ST
Second Line	:	CONVENTUS BUILDING 3RD FLOOR
City	:	BUFFALO
State	:	NY
Zip	:	14202-1102
Country	:	US
Telephone Number	:	716-323-6210
Fax Number	:	716-323-6691

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/19/2022

1028 MAIN ST
BUFFALO, NY
14202-1102

Practice Phone: 716-859-5454
Practice Fax: 716-859-5585