Provider Demographics
NPI:1356315089
Name:LAUREL OB GYN PA
Entity Type:Organization
Organization Name:LAUREL OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-253-5381
Mailing Address - Street 1:41 OAKLAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4820
Mailing Address - Country:US
Mailing Address - Phone:828-253-5381
Mailing Address - Fax:
Practice Address - Street 1:41 OAKLAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4820
Practice Address - Country:US
Practice Address - Phone:828-253-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890203AMedicaid
NC230484Medicare ID - Type Unspecified