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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