Provider Demographics
NPI:1790348472
Name:ARCHIBALD, LAURA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:JOY
Other - Last Name:KOOISTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 ERDMAN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1840
Mailing Address - Country:US
Mailing Address - Phone:978-751-9280
Mailing Address - Fax:978-627-3923
Practice Address - Street 1:80 ERDMAN WAY STE 100
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-751-9280
Practice Address - Fax:978-627-3923
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023399207N00000X, 207ND0101X
IN01092483A207ND0101X
MN73044207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery