Provider Demographics
NPI:1588688469
Name:WEIDENFELD, LAURA H (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:H
Last Name:WEIDENFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2953 KEDLESTON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2232
Mailing Address - Country:US
Mailing Address - Phone:702-363-3000
Mailing Address - Fax:702-363-3161
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-363-3000
Practice Address - Fax:702-363-3161
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018144Medicaid