Provider Demographics
NPI:1598740714
Name:BORTHWICK, LAURA A (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:BORTHWICK
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 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1338
Mailing Address - Country:US
Mailing Address - Phone:215-914-4400
Mailing Address - Fax:215-657-4887
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1338
Practice Address - Country:US
Practice Address - Phone:215-914-4400
Practice Address - Fax:215-657-4887
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072216L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001864740001Medicaid
PA001864740001Medicaid
PA047731L5JMedicare PIN