Provider Demographics
NPI:1528174513
Name:WILLIAM L LAURY MD PC
Entity type:Organization
Organization Name:WILLIAM L LAURY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAURY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-924-4440
Mailing Address - Street 1:834 E UPSAL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1541
Mailing Address - Country:US
Mailing Address - Phone:215-924-4440
Mailing Address - Fax:610-525-0852
Practice Address - Street 1:834 E UPSAL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1541
Practice Address - Country:US
Practice Address - Phone:215-924-4440
Practice Address - Fax:610-525-0852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006482400004Medicaid
PA2166OtherBRAVO ELDER HEALTH
PA7104021OtherAETNA
PA075910OtherBC BS
PA1078975OtherKEYSTONE MERCY
PA0064824003OtherAMERICHOICE OF PA
PAP00079200OtherRAILROAD MEDICARE
PAP526589OtherOXFORD HEALTH
PA0054066000OtherIBC
PA37461OtherHEALTH PARTNERS
PA075910OtherBC BS
PAP526589OtherOXFORD HEALTH