Provider Demographics
NPI:1467407163
Name:LAU, STEPHEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:LAU
Suffix:
Gender:M
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:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1633
Mailing Address - Country:US
Mailing Address - Phone:304-637-8700
Mailing Address - Fax:304-637-2323
Practice Address - Street 1:909 GORMAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4109
Practice Address - Country:US
Practice Address - Phone:304-637-8700
Practice Address - Fax:304-637-2323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1423749OtherUMWA
WVV004519OtherCHAMPUS
WVWV16413OtherHEALTH PLAN
WV0128953000Medicaid
WV197648OtherBLACK LUNG
WVV004519OtherCHAMPUS
WV0128953000Medicaid