Provider Demographics
NPI:1912193970
Name:OUTLAW, LAUREN GEVANA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:GEVANA
Last Name:OUTLAW
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 1:101 E CHARLES ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4901
Mailing Address - Country:US
Mailing Address - Phone:301-609-4800
Mailing Address - Fax:571-405-6234
Practice Address - Street 1:101 E CHARLES ST STE 104
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4901
Practice Address - Country:US
Practice Address - Phone:301-609-4800
Practice Address - Fax:240-901-2958
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD90375207V00000X
IN11013256A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000675487OtherANTHEM IN - BMA
IN000000873394OtherBCBS
IN200898630Medicaid
IN200898630 FWOMedicaid
IN01064686AOtherPHYSICIAN LICENSE
IN000000675480OtherANTHEM IN - FWO
IN000000873394OtherBCBS
IN01064686AOtherPHYSICIAN LICENSE
IN000000675487OtherANTHEM IN - BMA