Basic Information
| Provider Information | |||||||||
| NPI: | 1467403972 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOGIA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 856 J CLYDE MORRIS BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944006 | ||||||||
| FaxNumber: | 7575942195 | ||||||||
| Practice Location | |||||||||
| Address1: | 648 HOSPITAL RD | ||||||||
| Address2: | SUITE B-305 | ||||||||
| City: | TAPPAHANNOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225605000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044436240 | ||||||||
| FaxNumber: | 8044436244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 0101239247 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1467403972 | 05 | VA | MEDICAID |