Provider Demographics
NPI:1760572051
Name:STOUGH, LAURA J (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:STOUGH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:158 N MAIN ST
Mailing Address - Street 2:PO BOX 299
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1133
Mailing Address - Country:US
Mailing Address - Phone:845-651-1400
Mailing Address - Fax:845-651-1510
Practice Address - Street 1:721 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:MAYBROOK
Practice Address - State:NY
Practice Address - Zip Code:12543-1307
Practice Address - Country:US
Practice Address - Phone:845-427-0884
Practice Address - Fax:845-427-9072
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NY010959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MR1342891OtherDEA