Provider Demographics
NPI:1598926685
Name:YABLON, LAURIE ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ELLEN
Last Name:YABLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FAIRFAX AVE.
Mailing Address - Street 2:FAIRFAX HALL-6TH FLOOR EVMS PHYSICAL MED&REHAB
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1914
Mailing Address - Country:US
Mailing Address - Phone:757-446-8496
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE.
Practice Address - Street 2:FAIRFAX HALL-6TH FLOOR EVMS PHYSICAL MED&REHAB
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116020612208100000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation