Provider Demographics
NPI:1659507945
Name:MCCRACKEN, LAURA DIONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DIONNE
Last Name:MCCRACKEN
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 1:2 STATE ROUTE 27 STE 500
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:732-516-9868
Mailing Address - Fax:732-516-9869
Practice Address - Street 1:2 STATE ROUTE 27 STE 500
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-516-9868
Practice Address - Fax:732-516-9869
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06639400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics