Provider Demographics
NPI:1316960057
Name:LAURIA, MICHELE RENEE (MD, MS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:LAURIA
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ARGYLE PARK
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1205
Mailing Address - Country:US
Mailing Address - Phone:603-340-3644
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:CONVENTUS BUILDING 3RD FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1102
Practice Address - Country:US
Practice Address - Phone:716-323-6210
Practice Address - Fax:716-323-6691
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20782207VM0101X
NH10213207VM0101X
NY186886-1207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011072Medicaid
VT0RE4682Medicaid
NHDX7135Medicare PIN
NHDX7136Medicare PIN
NH30011072Medicaid