Provider Demographics
NPI:1548557523
Name:BUJOLD, LAURA (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BUJOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KUBICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1207
Mailing Address - Country:US
Mailing Address - Phone:860-714-4212
Mailing Address - Fax:
Practice Address - Street 1:99 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1207
Practice Address - Country:US
Practice Address - Phone:860-714-4212
Practice Address - Fax:860-714-8080
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017729207Q00000X
CT15191538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine