Provider Demographics
NPI:1134122773
Name:LAURIA, PHILIP GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GERARD
Last Name:LAURIA
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 1:240 RED TAIL RD
Mailing Address - Street 2:SUITE 1&2
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1581
Mailing Address - Country:US
Mailing Address - Phone:716-649-6500
Mailing Address - Fax:716-649-0031
Practice Address - Street 1:240 RED TAIL RD
Practice Address - Street 2:SUITE 1&2
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1581
Practice Address - Country:US
Practice Address - Phone:716-649-6500
Practice Address - Fax:716-649-0031
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1853181207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005118101OtherCOMMUNITY BLUE
NY00664535Medicaid
NY0705528OtherIHA
NY161019149OtherAETNA
NY161019149OtherNORTH AMERICAN
NY161019149OtherFIDELIS
NY161019149OtherUNITED HEALTH CARE
NY10099901OtherUNIVERA
NY161019149OtherNOVA
NYF51558Medicare UPIN
NY0705528OtherIHA