Provider Demographics
NPI:1316955248
Name:BOOTH, LAURA J (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1419
Mailing Address - Country:US
Mailing Address - Phone:585-292-6440
Mailing Address - Fax:585-292-6491
Practice Address - Street 1:945 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1419
Practice Address - Country:US
Practice Address - Phone:585-292-6440
Practice Address - Fax:585-292-6491
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDG244OtherPREFERRED CARE
NYP010171560OtherEXCELLUS
NY4343442OtherAETNA
NY01443163Medicaid
NYMDG244OtherPREFERRED CARE