Provider Demographics
NPI:1134108186
Name:LAUDICINA, LAURENCE R (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:R
Last Name:LAUDICINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 JEFFERSON ST NE STE 800
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2132
Mailing Address - Country:US
Mailing Address - Phone:505-418-6636
Mailing Address - Fax:505-521-5160
Practice Address - Street 1:4700 JEFFERSON ST NE STE 800
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2132
Practice Address - Country:US
Practice Address - Phone:505-932-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0045207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76736326Medicaid
NMPENDINGMedicare PIN
NMNM300337Medicare PIN