Provider Demographics
NPI:1578591681
Name:MCELRATH, LAURIE ANNE (OD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:MCELRATH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E NESHANNOCK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1144
Mailing Address - Country:US
Mailing Address - Phone:724-656-1117
Mailing Address - Fax:724-656-1566
Practice Address - Street 1:144 E NESHANNOCK AVE
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1144
Practice Address - Country:US
Practice Address - Phone:724-656-1117
Practice Address - Fax:724-656-1566
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-006600-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001730942Medicaid
PA001730942Medicaid
109581WDWMedicare PIN