Provider Demographics
NPI:1053635011
Name:PHILLIPS-CHOU, LAURA D (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:PHILLIPS-CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DAWN
Other - Last Name:PHILLIPS-CHOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6503 E BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1692
Mailing Address - Country:US
Mailing Address - Phone:614-434-5437
Mailing Address - Fax:614-454-5438
Practice Address - Street 1:6503 E BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1692
Practice Address - Country:US
Practice Address - Phone:614-434-5437
Practice Address - Fax:614-454-5438
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084872Medicaid