Provider Demographics
NPI:1326316464
Name:LUBIN, LAURA VENABLES (OTR)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:VENABLES
Last Name:LUBIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 ASTILBE WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2931
Mailing Address - Country:US
Mailing Address - Phone:410-919-7459
Mailing Address - Fax:410-695-0805
Practice Address - Street 1:2037 ASTILBE WAY
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2931
Practice Address - Country:US
Practice Address - Phone:410-919-7459
Practice Address - Fax:410-695-0805
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist