Provider Demographics
NPI:1235134172
Name:OSTHAUS, LAURA E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:OSTHAUS
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 1:55 CLAIREDAN DR.
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065
Mailing Address - Country:US
Mailing Address - Phone:614-888-8989
Mailing Address - Fax:614-888-8968
Practice Address - Street 1:55 CLAIREDAN DR.
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:614-888-8989
Practice Address - Fax:614-888-8968
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-1483-0208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2501091Medicaid