Provider Demographics
NPI:1285670844
Name:SCOVILLE, LAURA L (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SCOVILLE
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 1:30 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-665-4590
Mailing Address - Fax:413-582-2566
Practice Address - Street 1:30 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-665-4590
Practice Address - Fax:413-582-2566
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204267207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ23596OtherBCBA OF MA
MA0133141Medicaid
MA28648OtherHEALTH NEW ENGLAND
MA000000007855OtherBMC HEALTHNET
MA5288121OtherAETNA
MA043194547OtherCIGNA
MA690987OtherHARVARD PILGRIM HEALTH PL
MA204267OtherCONNECTICARE
MA204267OtherTUFTS HEALTH PLAN
MAC96792Medicare UPIN