Provider Demographics
NPI:1922204759
Name:DE GRAND, LAURIE UPTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:UPTON
Last Name:DE GRAND
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 1:828 HEALTHY WAY STE 330
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7959
Mailing Address - Country:US
Mailing Address - Phone:757-461-3890
Mailing Address - Fax:757-467-0301
Practice Address - Street 1:828 HEALTHY WAY STE 330
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7959
Practice Address - Country:US
Practice Address - Phone:757-461-3890
Practice Address - Fax:757-467-0301
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250763207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-002OtherTRICARE/CHAMPUS
VA448890OtherANTHEM BC/BS
NC5918931Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VA1922204759OtherVIRGINIA PREMIER HEALTH PLAN
VA1922204759Medicaid
VAPAROtherAETNA
VA1922204759OtherUNITED HEALTHCARE
VAPAROtherCORVEL
VA10085658OtherOPTIMA HEALTH
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VA1922204759OtherCOVENTRY NATIONAL/SOUTHERN HEALTH SERVICES
VA-002OtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN