Provider Demographics
NPI:1376073171
Name:MICHETTI, LAURA ASHLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ASHLEY
Last Name:MICHETTI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WEST ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2824
Mailing Address - Country:US
Mailing Address - Phone:410-573-1111
Mailing Address - Fax:410-573-1377
Practice Address - Street 1:168 WEST ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2824
Practice Address - Country:US
Practice Address - Phone:410-573-1111
Practice Address - Fax:410-573-1377
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL9802213ES0103X
MD01703213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery