Provider Demographics
NPI:1225300072
Name:KEVIN L LASER MD
Entity Type:Organization
Organization Name:KEVIN L LASER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:LASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-615-3707
Mailing Address - Street 1:512 BENFOREST DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1735
Mailing Address - Country:US
Mailing Address - Phone:410-615-3707
Mailing Address - Fax:
Practice Address - Street 1:512 BENFOREST DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1735
Practice Address - Country:US
Practice Address - Phone:410-615-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD355602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty