Provider Demographics
NPI:1558335117
Name:WHITE, LAURA K (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:WHITE
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 1:8185 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-398-7171
Mailing Address - Fax:513-398-8683
Practice Address - Street 1:8185 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-398-7171
Practice Address - Fax:513-398-8683
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073272208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2316212OtherAETNA
OH000000074949OtherANTHEM BC/BS
OH1201812OtherUNITED HEALTHCARE
OH0714776Medicaid
OH7327201OtherHUMANA