Provider Demographics
NPI:1518993294
Name:THORNBURG, LORALEI L (MD)
Entity Type:Individual
Prefix:
First Name:LORALEI
Middle Name:L
Last Name:THORNBURG
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-487-3352
Mailing Address - Fax:585-256-1416
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-487-3352
Practice Address - Fax:585-256-1416
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234391207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010234391OtherBLUE CHOICE
NY02634908Medicaid
NY7230738OtherAETNA
NYMDJ028OtherPREFERRED CARE
NYP030234391OtherBLUE SHIELD OF ROCHESTER
NY7230738OtherAETNA
NYJ400000852Medicare PIN
J400043515Medicare PIN
NYP030234391OtherBLUE SHIELD OF ROCHESTER
NYI30162Medicare UPIN