Provider Demographics
NPI:1760565345
Name:LAUGHLIN, MARY BARNETT (PAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BARNETT
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:LIMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04049-0003
Mailing Address - Country:US
Mailing Address - Phone:207-637-2380
Mailing Address - Fax:
Practice Address - Street 1:1 VA CENTER
Practice Address - Street 2:AUGUSTA VA
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA716208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice