Provider Demographics
NPI:1427075514
Name:VERBOSKY, LAURIE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANNE
Last Name:VERBOSKY
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 1:935 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1957
Mailing Address - Country:US
Mailing Address - Phone:513-675-0085
Mailing Address - Fax:
Practice Address - Street 1:935 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1957
Practice Address - Country:US
Practice Address - Phone:513-675-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081790207Q00000X, 207QG0300X
KY39481207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVE4095335Medicare PIN
KY0793814Medicare PIN
OHVE4095332Medicare PIN
OHVE4095337Medicare PIN
OHVE4095334Medicare PIN
OHVE4095333Medicare PIN
OHH72880Medicare UPIN
OHVE4095331Medicare PIN