Provider Demographics
NPI:1912299074
Name:MAHER, LAURA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:MAHER
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 1:4030 W. HENDERSON RD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2287
Mailing Address - Country:US
Mailing Address - Phone:614-442-7550
Mailing Address - Fax:614-442-4100
Practice Address - Street 1:4030 W. HENDERSON RD.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2287
Practice Address - Country:US
Practice Address - Phone:614-442-7550
Practice Address - Fax:614-442-4100
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-122887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105529Medicaid
OH0105529Medicaid