Provider Demographics
NPI:1689635054
Name:PROIA, LAURIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:PROIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-723-7719
Mailing Address - Fax:585-723-7834
Practice Address - Street 1:1561 LONG POND RD STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4135
Practice Address - Country:US
Practice Address - Phone:585-723-7719
Practice Address - Fax:585-723-7834
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY261114207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL440003643OtherRR MEDICARE
IL036094851Medicaid
IL036094851Medicaid
ILL73830Medicare PIN