Provider Demographics
NPI:1356456636
Name:KOSKINEN, LAURIN (MD)
Entity Type:Individual
Prefix:
First Name:LAURIN
Middle Name:
Last Name:KOSKINEN
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 1:451 ANDOVER ST
Mailing Address - Street 2:STE 205
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5079
Mailing Address - Country:US
Mailing Address - Phone:207-795-7575
Mailing Address - Fax:
Practice Address - Street 1:1145 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1025
Practice Address - Country:US
Practice Address - Phone:781-480-1976
Practice Address - Fax:781-480-1981
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOX2348Medicare UPIN