Provider Demographics
NPI:1669443875
Name:BORN, LAURA J (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:BORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1833 IVY CREST DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3822
Mailing Address - Country:US
Mailing Address - Phone:615-890-1455
Mailing Address - Fax:615-890-1674
Practice Address - Street 1:2933 MEDICAL CENTER PKWY STE A
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2391
Practice Address - Country:US
Practice Address - Phone:615-890-1455
Practice Address - Fax:615-890-1455
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065843L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
H31942Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE