Provider Demographics
NPI:1144710575
Name:PEDERSEN, LAURA LEE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E MARSHALL ST # 980049
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-1900
Mailing Address - Country:US
Mailing Address - Phone:804-828-9711
Mailing Address - Fax:804-828-3097
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:048-828-9711
Practice Address - Fax:804-828-3097
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281284207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease