Provider Demographics
NPI:1295774768
Name:PIERCE, LAURA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:PIERCE
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 1:1331 E VICTOR RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9395
Mailing Address - Country:US
Mailing Address - Phone:585-924-2100
Mailing Address - Fax:585-924-5920
Practice Address - Street 1:1331 E VICTOR RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9395
Practice Address - Country:US
Practice Address - Phone:585-924-2100
Practice Address - Fax:585-924-5920
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197675207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000916472001OtherHEALTH NOW SYRACUSE NY
7951259OtherAETNA
P010197675OtherBLUE CHOICE ROCHESTER NY
NY01857249Medicaid
1015558BJOtherPREFERRED CARE ROCHESTER
110217618OtherRR MEDICARE
1139OtherBC/BS ROCHESTER NY
NY01857249Medicaid
1015558BJOtherPREFERRED CARE ROCHESTER