Provider Demographics
NPI:1952435737
Name:BUCHWALD, LAURIE A (NP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:BUCHWALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEALTH PARK DR FL HP2
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:614 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1818
Practice Address - Country:US
Practice Address - Phone:540-443-0500
Practice Address - Fax:540-553-0526
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024097454363LX0001X
VA0017000837363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01799998Medicare PIN
VAVV6279AMedicare PIN