Individual
LAURA DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-3375
(215) 707-4758
Mailing address
2450 W HUNTING PARK AVE FL TASB3, PHILADELPHIA, PA 19129-1302
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD466826
PA
Other
Enumeration date
03/21/2013
Last updated
05/30/2019
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