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Organization
PLUMTREE PEDIATRICS, LLC
Active
Organization
PLUMTREE PEDIATRICS, LLC
Active
Other names
LAUREL PEDIATRIC AND TEEN MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENEROSA CRUZ LAZOR MD (DIRECTOR)
(410) 569-9533
Entity
Organization
Contact information
Practice address
2014 S TOLLGATE RD, SUITE 200, BEL AIR, MD 21015-5903
(410) 569-9533
(410) 569-1254
Mailing address
2014 S TOLLGATE RD, SUITE 200, BEL AIR, MD 21015-5903
(410) 569-9533
(410) 569-1254
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D34413
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293901100
—
MD
05
—
408959600
—
MD
Enumeration date
08/06/2006
Last updated
12/29/2014
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