Provider Demographics
NPI:1700804143
Name:BROWNGOEHL, LAURIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:BROWNGOEHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-7130
Mailing Address - Country:US
Mailing Address - Phone:610-527-8808
Mailing Address - Fax:610-527-8868
Practice Address - Street 1:551 W LANCASTER AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1419
Practice Address - Country:US
Practice Address - Phone:610-527-8808
Practice Address - Fax:610-527-8868
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0332325208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025917Medicaid
B34958Medicare UPIN
PA071670Medicare PIN