Provider Demographics
NPI:1033318373
Name:SORG, LAURA L (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SORG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEIGH
Other - Last Name:SORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:140 COLEMANS CROSSING BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-0000
Mailing Address - Country:US
Mailing Address - Phone:937-644-1441
Mailing Address - Fax:937-642-7760
Practice Address - Street 1:140 COLEMANS CROSSING BOULEVARD
Practice Address - Street 2:SUITE 210
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-0000
Practice Address - Country:US
Practice Address - Phone:937-644-1441
Practice Address - Fax:937-642-7760
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3068488Medicaid
OHH065331Medicare PIN