Provider Demographics
NPI:1851889174
Name:ROULEAU, LAUREN (MD PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:NEVELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6571 RUDDEROW AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2838
Mailing Address - Country:US
Mailing Address - Phone:610-762-8129
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-251-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program