Provider Demographics
NPI:1326022575
Name:LAURY, JOEL J (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:J
Last Name:LAURY
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 1:1000 MEADE ST STE 211
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3195
Mailing Address - Country:US
Mailing Address - Phone:570-215-8001
Mailing Address - Fax:949-757-3831
Practice Address - Street 1:1000 MEADE ST STE 211
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3195
Practice Address - Country:US
Practice Address - Phone:570-215-8001
Practice Address - Fax:949-757-3831
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055731L207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001536631Medicaid
PAF65123Medicare UPIN
PA781443NW4Medicare PIN
PA001536631Medicaid