Provider Demographics
NPI:1225190929
Name:CAREY, LAURA (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2157
Mailing Address - Country:US
Mailing Address - Phone:585-266-0736
Mailing Address - Fax:585-266-1612
Practice Address - Street 1:1742 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2157
Practice Address - Country:US
Practice Address - Phone:585-266-0736
Practice Address - Fax:585-266-1612
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7557363A00000X
NY007557-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019007557OtherEXCELLUS BLUE CROSS BLUE SHIELD
NY109528OtherPREFERRED CARE
PA2549Medicare UPIN