Provider Demographics
NPI:1841207677
Name:WATERS, LAUREL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:ANN
Last Name:WATERS
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 1:5 DOLORES CT
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1574
Mailing Address - Country:US
Mailing Address - Phone:925-457-3664
Mailing Address - Fax:925-377-0543
Practice Address - Street 1:5 DOLORES CT
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1574
Practice Address - Country:US
Practice Address - Phone:925-457-3664
Practice Address - Fax:925-377-0543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46277207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25021Medicare UPIN
00G462770Medicare ID - Type Unspecified