Provider Demographics
NPI:1730127267
Name:CRIM, LAURA E (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:CRIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1720
Mailing Address - Country:US
Mailing Address - Phone:717-267-7146
Mailing Address - Fax:717-267-7728
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7146
Practice Address - Fax:717-267-7728
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070368L207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001793924Medicaid
036867Medicare ID - Type Unspecified
PA001793924Medicaid