Gifford, Laura Eastburn Keck

Gifford, Laura Eastburn Keck is an individual health care provider with primary practice located at 1221 Mercantile Ln , Largo MD 20774. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Gifford, Laura Eastburn Keck can be contacted via phone (800) 777-7904.

Contact Information

Primary practice address
1221 Mercantile Ln Largo MD 20774
Phone: (800) 777-7904
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X ME121790 Florida
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 151494 Oregon
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 0101261499 Virginia

Profile Details

NPI number 1508184557
LBN Legal business name Gifford, Laura Eastburn Keck
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 13th, 2010
Last updated Jun 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508184557 NPPES
Florida MEDICAID 014109700

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