Provider Demographics
NPI:1770784118
Name:LAURA M. MUMFORD, M.D.,P.A.
Entity type:Organization
Organization Name:LAURA M. MUMFORD, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-583-0390
Mailing Address - Street 1:10755 FALLS RD
Mailing Address - Street 2:STE 470
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4515
Mailing Address - Country:US
Mailing Address - Phone:410-583-0390
Mailing Address - Fax:410-583-0603
Practice Address - Street 1:10755 FALLS RD
Practice Address - Street 2:STE 470
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4515
Practice Address - Country:US
Practice Address - Phone:410-583-0390
Practice Address - Fax:410-583-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty