MEDICARE: LAURA KELLAM PRATT MD

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	207N00000X	Dermatology Physician	0101231692	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00047267	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	7442479	OTHER	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0300585	OTHER	UNITED HEALTHCARE
5	230056	OTHER	SOUTHERN HEALTH
6	465745	OTHER	ANTHEM

General Provider Information

NPI Number	:	1548260912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KELLAM PRATT MD

Provider Business Mailing Address
First Line	:	301 CONCOURSE BLVD
Second Line	:	SUITE 190
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5643
Country	:	US
Telephone Number	:	804-549-4030
Fax Number	:	804-549-4032

Provider Business Practice Location Address
First Line	:	280 CHARLES DIMMOCK PKWY
Second Line	:	SUITE 4
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2940
Country	:	US
Telephone Number	:	804-526-7364
Fax Number	:	804-526-7394

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/31/2014

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Directions to “ LAURA KELLAM PRATT MD” Practice Location

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