Provider Demographics
NPI:1063460194
Name:RICE, LAURIE C (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:C
Last Name:RICE
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 95000-2454
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2454
Mailing Address - Country:US
Mailing Address - Phone:914-749-7000
Mailing Address - Fax:
Practice Address - Street 1:55 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4337
Practice Address - Country:US
Practice Address - Phone:212-252-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02443103Medicaid
NY92S861Medicare ID - Type Unspecified
NY02443103Medicaid