Provider Demographics
NPI:1417070236
Name:NORTHUP, LAUREL PUCK (MD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:PUCK
Last Name:NORTHUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:#307
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-493-8984
Mailing Address - Fax:301-493-8985
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:#307
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-493-8984
Practice Address - Fax:301-493-8985
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD424312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry