Provider Demographics
NPI:1073575049
Name:HENSELER, LAURA J (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:HENSELER
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 1:3461 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1465
Mailing Address - Country:US
Mailing Address - Phone:401-471-6760
Mailing Address - Fax:401-471-6765
Practice Address - Street 1:146 W RIVER ST # 11A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-793-8770
Practice Address - Fax:401-793-8709
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10303207Q00000X
RIMD103032084P0800X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPENDINGMedicaid
RIG 12889Medicare UPIN
RIPENDINGMedicaid