Basic Information
| Provider Information | |||||||||
| NPI: | 1598043416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEJIA | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 JEFFERSON AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | JEANNETTE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156442538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245278060 | ||||||||
| FaxNumber: | 7245274002 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 W PITTSBURGH ST | ||||||||
| Address2: | INTERNAL MEDICINE DEPARTMENT | ||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248324000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD446859 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MT195381 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD446859 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102763172 | 05 | PA | MEDICAID | 207R00000X | 05 | PA | MEDICAID | MD446859 | 01 | PA | MEDICAL PHYSICIAN AND SURGEON LICENSE | OTHER |