Provider Demographics
NPI:1770846552
Name:MONG, LAURA ELISABETH (DO)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELISABETH
Last Name:MONG
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:135 N EWING ST STE 301
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3379
Practice Address - Country:US
Practice Address - Phone:740-689-4925
Practice Address - Fax:740-689-4885
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2019-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.011972207QS1201X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184582Medicaid
OHH454220Medicare PIN