Provider Demographics
NPI:1124467527
Name:LAURENT-ROLLE, MAUDRY (MD/PHD)
Entity type:Individual
Prefix:DR
First Name:MAUDRY
Middle Name:
Last Name:LAURENT-ROLLE
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208022
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8022
Mailing Address - Country:US
Mailing Address - Phone:203-785-4140
Mailing Address - Fax:203-785-3964
Practice Address - Street 1:136 MURPHY LN
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058-8122
Practice Address - Country:US
Practice Address - Phone:646-263-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT61464208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program