Provider Demographics
NPI:1558584037
Name:SU, LAURA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:SU
Suffix:
Gender:
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 1:2414 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1023
Mailing Address - Country:US
Mailing Address - Phone:650-283-5556
Mailing Address - Fax:
Practice Address - Street 1:PHILADELPHIA VA MEDICAL CENTER
Practice Address - Street 2:3900 WOODLAND AVENUE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5000
Practice Address - Country:US
Practice Address - Phone:650-283-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87919207RR0500X
PAMD450517207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology