Provider Demographics
NPI:1407802697
Name:LAURY, WILLIAM L SR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:LAURY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:175 W COHAWKIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1145
Mailing Address - Country:US
Mailing Address - Phone:856-423-7700
Mailing Address - Fax:856-423-0823
Practice Address - Street 1:834 E UPSAL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1541
Practice Address - Country:US
Practice Address - Phone:215-924-4440
Practice Address - Fax:215-927-4777
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016761E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0064824003OtherAMERICHOICE
PA0054066000OtherIBC
PA7104021OtherAETNA
PA37462OtherHEALTH PARTNERS PA
PAP526589OtherOXFORD HEALTH
PA37461OtherHEALTH PARTNERS PA
PAP00079200OtherRAILROAD MEDICARE
PA0006482400004Medicaid
PA1078975OtherKEYSTONE MERCY
PA2166OtherBRAVO ELDER HEALTH
PA0054066000OtherIBC
PA0006482400004Medicaid