Provider Demographics
NPI:1548310220
Name:LAURENS, MATTHEW BRENT (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRENT
Last Name:LAURENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:685 W BALTIMORE ST
Mailing Address - Street 2:RM 480
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1509
Mailing Address - Country:US
Mailing Address - Phone:410-706-5328
Mailing Address - Fax:410-706-1204
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-706-5328
Practice Address - Fax:410-706-1204
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63115207RI0200X, 2080P0208X
MD63115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012499100Medicaid
MD012499100Medicaid
MDR157Medicare PIN