Provider Demographics
NPI:1154438869
Name:LAUREL UROLOGY INC
Entity type:Organization
Organization Name:LAUREL UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIBAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARIKOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-536-7851
Mailing Address - Street 1:1111 FRANKLIN ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-536-7851
Mailing Address - Fax:814-539-3649
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:SUITE 410
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-536-7851
Practice Address - Fax:814-539-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
747979OtherHIGHMARK BCBS
PACM4006OtherRAILROAD MEDICARE
PA0006394830001Medicaid
747979OtherHIGHMARK BCBS