Provider Demographics
NPI:1295250728
Name:YORK, LAURA (PAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 THOMAS JOHNSON CT STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4674
Mailing Address - Country:US
Mailing Address - Phone:301-620-4200
Mailing Address - Fax:301-620-0879
Practice Address - Street 1:81 THOMAS JOHNSON CT STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4674
Practice Address - Country:US
Practice Address - Phone:301-620-4200
Practice Address - Fax:301-620-0879
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002703363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical