Provider Demographics
NPI:1366402687
Name:MATHIE, LAURIE W (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:W
Last Name:MATHIE
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 1:160 GALLERY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:724-934-2550
Mailing Address - Fax:724-935-5558
Practice Address - Street 1:160 GALLERY DR STE 200
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:724-934-2550
Practice Address - Fax:724-935-5558
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420492207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11465007OtherCAQH
PA101258911Medicaid
PA1734213OtherBLUE SHIELD
PAI29132Medicare UPIN
PA090914G5FMedicare PIN
PA090914XSAMedicare PIN
PA090914JJ6Medicare PIN