Provider Demographics
NPI:1114000957
Name:O'GORMAN, LAURA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:O'GORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:VRLENICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-4003
Mailing Address - Country:US
Mailing Address - Phone:573-815-9700
Mailing Address - Fax:573-815-0700
Practice Address - Street 1:1600 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-6814
Practice Address - Fax:573-815-3716
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1077412080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
17315OtherANTHEM BCBS PIN
11060392OtherCAQHPROVIDER ID
17676OtherHEALTHCARE USA PIN
271875OtherHEALTHLINK PIN
17676OtherHEALTHCARE USA PIN