Provider Demographics
NPI:1982049714
Name:ALCOCK, LAURIE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ALCOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 SWEET BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6304
Mailing Address - Country:US
Mailing Address - Phone:410-747-3667
Mailing Address - Fax:
Practice Address - Street 1:5305 SWEET BIRCH CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6304
Practice Address - Country:US
Practice Address - Phone:410-747-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12526045OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE (CAQH)