Provider Demographics
NPI:1659373280
Name:LAULETTA, MARYANN CARMELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:CARMELLA
Last Name:LAULETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:CARMELLA
Other - Last Name:GAROZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:151 FRIES MILL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2016
Mailing Address - Country:US
Mailing Address - Phone:856-401-9300
Mailing Address - Fax:856-374-5805
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-401-9300
Practice Address - Fax:856-374-5805
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07602600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027464Medicaid
071012Medicare ID - Type Unspecified
NJ0027464Medicaid