Individual
ISAGANI D LAURENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10701 NEW GEORGES CREEK RD SW, FROSTBURG, MD 21532-1457
(301) 689-3229
(301) 689-1129
Mailing address
408 KEAN TER, CUMBERLAND, MD 21502-3322
(301) 759-2787
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
D19954
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050694000
—
WV
01
—
41665301
CAREFIRST BC BS
MD
01
—
E458 0015
BLUE CHOICE - HT. CLUB
DC
01
—
K029 0003
BLUE CHOICE DC
DC
01
—
LU39HU 416653 02
CAREFIRST BC BS - HT.CLUB
MD
Enumeration date
12/14/2005
Last updated
09/11/2007
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