Provider Demographics
NPI:1972257673
Name:MOORE, LAURA CAMPBELL (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CAMPBELL
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STONE HILL DR N
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4439
Mailing Address - Country:US
Mailing Address - Phone:802-279-8820
Mailing Address - Fax:
Practice Address - Street 1:3 STONE HILL DR N
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-4439
Practice Address - Country:US
Practice Address - Phone:802-279-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant