Provider Demographics
NPI:1619903770
Name:MARSH, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MARSH
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 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:MENTAL HEALTH CARE LINE 116; MICHAEL E. DEBAKEY VAMC
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:713-794-8907
Mailing Address - Fax:501-228-8694
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:MENTAL HEALTH CARE LINE 116; MICHAEL E. DEBAKEY VAMC
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-8907
Practice Address - Fax:501-228-8694
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD357522084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187440300Medicaid
MDF66363Medicare UPIN
MD187440300Medicaid