Provider Demographics
NPI:1467412429
Name:DUNPHY, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DUNPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570R HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3717
Mailing Address - Country:US
Mailing Address - Phone:508-999-5300
Mailing Address - Fax:508-961-1509
Practice Address - Street 1:570R HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3717
Practice Address - Country:US
Practice Address - Phone:508-999-5300
Practice Address - Fax:508-961-1509
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2016478Medicaid
MAA36111Medicare ID - Type Unspecified
MA2016478Medicaid