Provider Demographics
NPI:1881670974
Name:LAUS, AGNES M (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:M
Last Name:LAUS
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 1:1781 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1186
Mailing Address - Country:US
Mailing Address - Phone:740-687-8600
Mailing Address - Fax:740-653-8236
Practice Address - Street 1:1781 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4056
Practice Address - Country:US
Practice Address - Phone:740-687-8600
Practice Address - Fax:740-653-8236
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070728L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
510450201027OtherCARESOURCE
000000323677OtherANTHEM
OH0273396Medicaid