Provider Demographics
NPI:1770658205
Name:GREGORY R LAURO PC
Entity Type:Organization
Organization Name:GREGORY R LAURO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-532-1118
Mailing Address - Street 1:5840 STATE ROUTE 981
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5385
Mailing Address - Country:US
Mailing Address - Phone:724-532-1118
Mailing Address - Fax:724-532-1307
Practice Address - Street 1:5840 STATE ROUTE 981
Practice Address - Street 2:SUITE 101
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5385
Practice Address - Country:US
Practice Address - Phone:724-532-1118
Practice Address - Fax:724-532-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043988L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA515624OtherAETNA PROVIDER NUMBER
PA1016198530001Medicaid
PA427535OtherH AMERICAH ASSURANCE NUM
PA182388OtherUNISON ADVANTAGE
PA515624OtherAETNA PROVIDER NUMBER
PAE68488Medicare UPIN
PA712911U6VMedicare ID - Type UnspecifiedRENDERING PROVIDER ID
PA182388OtherUNISON ADVANTAGE
PA1016198530001Medicaid
PA155629Medicare PIN