Basic Information
| Provider Information | |||||||||
| NPI: | 1548478720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHARRY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ISABEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EICHHORN-WHARRY | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | ISABEL | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | CONRAD JOBST TOWER, SUITE 220 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192915150 | ||||||||
| FaxNumber: | 4194796173 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | CONRAD JOBST TOWER, SUITE 220 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192915150 | ||||||||
| FaxNumber: | 4194796173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2007 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301087646 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD444725 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 35.121359 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.