Provider Demographics
NPI:1053474759
Name:REGAN, LAURA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELIZABETH
Last Name:REGAN
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:PO BOX 72605
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8017
Mailing Address - Country:US
Mailing Address - Phone:804-379-0116
Mailing Address - Fax:804-379-1088
Practice Address - Street 1:1316 ALVERSER PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-379-0116
Practice Address - Fax:804-379-1088
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0101238821207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7682749OtherAETNA NON-HMO
VA1178927OtherAETNA HMO
VA192334OtherANTHEM
VAP00308516Medicare PIN
VA192334OtherANTHEM