Provider Demographics
NPI:1275629792
Name:ARNOLD, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ARNOLD
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 1:15 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7997
Mailing Address - Country:US
Mailing Address - Phone:207-861-8800
Mailing Address - Fax:207-861-8801
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-861-8800
Practice Address - Fax:207-861-8801
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85-173711-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07394Medicare UPIN
UT005549202Medicare ID - Type UnspecifiedMEDICARE