Provider Demographics
NPI:1093913261
Name:LAURA M. DONALDSON, DO-PEDIATRICS, PC
Entity Type:Organization
Organization Name:LAURA M. DONALDSON, DO-PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-494-2519
Mailing Address - Street 1:44 SECOND STREET PIKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3830
Mailing Address - Country:US
Mailing Address - Phone:215-494-2519
Mailing Address - Fax:
Practice Address - Street 1:44 SECOND STREET PIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3830
Practice Address - Country:US
Practice Address - Phone:215-494-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010725L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty