Provider Demographics
NPI:1376632968
Name:KING, LAURA MOONEY (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MOONEY
Last Name:KING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-742-1567
Mailing Address - Fax:410-742-1906
Practice Address - Street 1:106 MILFORD STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-742-1567
Practice Address - Fax:410-742-1906
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003071207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q59265Medicare UPIN
H621N075Medicare ID - Type Unspecified