Provider Demographics
NPI:1497789853
Name:UDOFF, LAURENCE C (MD)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:C
Last Name:UDOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3015 WILLIAMS DR
Mailing Address - Street 2:#202
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4623
Mailing Address - Country:US
Mailing Address - Phone:703-289-1963
Mailing Address - Fax:703-698-3977
Practice Address - Street 1:3015 WILLIAMS DR
Practice Address - Street 2:#202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4623
Practice Address - Country:US
Practice Address - Phone:703-289-1963
Practice Address - Fax:703-698-3977
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-07-30
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Provider Licenses
StateLicense IDTaxonomies
MDD46191207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150951900Medicaid
MD150951900Medicaid