Provider Demographics
NPI:1598737256
Name:TYREE, LAURA L (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:TYREE
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 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-750-7150
Mailing Address - Fax:215-750-7153
Practice Address - Street 1:407 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5526
Practice Address - Country:US
Practice Address - Phone:215-750-7150
Practice Address - Fax:215-750-7153
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075406207V00000X
PAMD454960207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3937492000OtherKEYSTONE IBC
NJ0004511Medicaid
PA1030399600002Medicaid
PA2405424OtherCIGNA PA
PA30249172OtherKEYSTONE FIRST
PA7874515OtherAETNA
PAP01534012OtherRAILROAD MEDICARE
PA3300851OtherHIGHMARK BLUE SHIELD
NJ0004511Medicaid
PAP01534012OtherRAILROAD MEDICARE