Provider Demographics
NPI:1023004322
Name:KORNEGAY, LAURA P (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HOUSTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2455
Mailing Address - Country:US
Mailing Address - Phone:540-463-2181
Mailing Address - Fax:540-463-1125
Practice Address - Street 1:108 HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2455
Practice Address - Country:US
Practice Address - Phone:540-463-2181
Practice Address - Fax:540-463-1125
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023004322Medicaid
VA1023004322Medicaid
VAMC12541Medicare PIN