Basic Information
| Provider Information | |||||||||
| NPI: | 1457371122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUGHLIN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9007 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229069007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002239173 | ||||||||
| FaxNumber: | 4342430064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 35-073914 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0000X | 0101248077 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 1051998 | 01 | OH | AETNA | OTHER | 2092435 | 05 | OH | MEDICAID | 741826 | 01 | OH | BUCKEYE | OTHER | P00123745 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000224296 | 01 | OH | UNISON | OTHER | 000000539581 | 01 | OH | ANTHEM | OTHER | 363743 | 01 | OH | WELLCARE | OTHER |