Provider Demographics
NPI:1881689099
Name:LASER, KEVIN LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LAWRENCE
Last Name:LASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BENFOREST DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1735
Mailing Address - Country:US
Mailing Address - Phone:410-544-7611
Mailing Address - Fax:410-544-5179
Practice Address - Street 1:512 BENFOREST DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1735
Practice Address - Country:US
Practice Address - Phone:410-544-7611
Practice Address - Fax:410-544-5179
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD355602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
15-00070OtherEVERCARE
MD52471105OtherCAREFIRST BCBS
DCK749OtherBCBS NATIONAL, FEP, BLUECHOICE
MD751621500Medicaid
$$$$$$$$$OtherSSN
MD52471105OtherCAREFIRST BCBS
DCK749OtherBCBS NATIONAL, FEP, BLUECHOICE
15-00070OtherEVERCARE
MD751621500Medicaid
DE491088Medicare PIN