Provider Demographics
NPI:1427051507
Name:EMMICK, LAURA S (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:EMMICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ISABELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 FOGG CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4103
Mailing Address - Country:US
Mailing Address - Phone:603-232-2704
Mailing Address - Fax:
Practice Address - Street 1:27 FOGG CT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4103
Practice Address - Country:US
Practice Address - Phone:603-232-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11693207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202199Medicaid
NH30202199Medicaid
NHRE6935Medicare PIN