Provider Demographics
NPI:1700844016
Name:CHARETTE, LAURA ALOIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ALOIS
Last Name:CHARETTE
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 1:917 GREAT MARSH AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0682
Mailing Address - Country:US
Mailing Address - Phone:757-548-0953
Mailing Address - Fax:
Practice Address - Street 1:2021 CONCERT DR
Practice Address - Street 2:SUITE 202
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-8082
Practice Address - Country:US
Practice Address - Phone:757-453-6711
Practice Address - Fax:757-301-6496
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046939208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700844016Medicaid
250440OtherANTHEM BLUE CROSS
13102OtherOPTIMA HEALTH CARE
VA1700844016Medicaid