Provider Demographics
NPI:1205028164
Name:BURDICK, LAURA MATHIS (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MATHIS
Last Name:BURDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:360 PLAZA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2960
Mailing Address - Country:US
Mailing Address - Phone:812-376-9686
Mailing Address - Fax:812-376-9697
Practice Address - Street 1:360 PLAZA DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2960
Practice Address - Country:US
Practice Address - Phone:812-376-9868
Practice Address - Fax:812-376-9697
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072756A207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology