Provider Demographics
NPI:1093788937
Name:GOLDSTICKER, LAURIE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:GOLDSTICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:GOLDSTICKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:400 W BRAMBLETON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1115
Mailing Address - Country:US
Mailing Address - Phone:757-627-6220
Mailing Address - Fax:757-627-0200
Practice Address - Street 1:400 W BRAMBLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1115
Practice Address - Country:US
Practice Address - Phone:757-627-6220
Practice Address - Fax:757-627-0200
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010180767Medicaid
VA541595397OtherVIRGINIA HEALTH NETWORK
VA11367OtherSENTARA/OPTIMA
VA5024100OtherAETNA
VA541595397OtherMID ATLANTIC SOLUTIONS
VA178893OtherANTHEM
VA541595397OtherCIGNA
008032B28Medicare PIN
VA541595397OtherMID ATLANTIC SOLUTIONS