Provider Demographics
NPI:1912388018
Name:ALBRIGHT, LAURA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:ALBRIGHT
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 1:2102 E INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2443
Mailing Address - Country:US
Mailing Address - Phone:574-299-2400
Mailing Address - Fax:574-299-2410
Practice Address - Street 1:2102 E INWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614
Practice Address - Country:US
Practice Address - Phone:574-299-2400
Practice Address - Fax:574-299-2410
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11018090A207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program