Provider Demographics
NPI:1255492286
Name:LAIRD, EMERSON LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:LEE
Last Name:LAIRD
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 1:1014 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2926
Mailing Address - Country:US
Mailing Address - Phone:740-397-3679
Mailing Address - Fax:
Practice Address - Street 1:11660 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9084
Practice Address - Country:US
Practice Address - Phone:740-392-2200
Practice Address - Fax:740-399-8012
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.025887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00065174OtherMEDICARE RAILROAD
OH000000233473OtherANTHEM BLUE CROSS-SHIELD
OH0014639Medicaid
OH000000233473OtherANTHEM BLUE CROSS-SHIELD
OHA70788Medicare UPIN