Individual
LAURAJEAN COUNCILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
3021 MOUNTAIN RD STE A, PASADENA, MD 21122-2015
(410) 437-9366
(410) 437-8107
Mailing address
3021 MOUNTAIN RD STE A, PASADENA, MD 21122-2015
(410) 437-9366
(410) 437-8107
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
08828
MD
213E00000X
Podiatrist
Primary
00971
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43428-8700
—
MD
01
—
KBQ4CO
BLUE CROSS BLUE SHIELD
MD
01
—
W219-0001
BLUE CROSS BLUE SHIELD
DC
Enumeration date
02/20/2007
Last updated
12/22/2022
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