Provider Demographics
NPI:1114907045
Name:PRICE, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PRICE
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 1:31 HALL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-253-3773
Mailing Address - Fax:413-256-0215
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-253-3773
Practice Address - Fax:413-256-0215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA24207OtherHEALTH NEW ENGLAND
MA01243301OtherCIGNA
MA202088OtherHARVARD PILGRIM HEALTH CA
MA04298OtherTUFTS HEALTH PLAN
MA2374889OtherAETNA
MA3053105Medicaid
MA717195OtherCONNECTICARE
MAJ09036OtherBLUE CROSS AND BLUE SHIEL
MA000000007636OtherBMC HEALTHNET
MA2374889OtherAETNA
MAJ09236Medicare ID - Type Unspecified