Provider Demographics
NPI:1871398800
Name:LAUREL MEDICAL GROUP
Entity type:Organization
Organization Name:LAUREL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY CHARNIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-751-3336
Mailing Address - Street 1:1050 S FLAMINGO RD
Mailing Address - Street 2:107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119
Mailing Address - Country:US
Mailing Address - Phone:702-751-3336
Mailing Address - Fax:702-442-8612
Practice Address - Street 1:1050 S FLAMINGO RD
Practice Address - Street 2:107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8911
Practice Address - Country:US
Practice Address - Phone:702-978-1648
Practice Address - Fax:702-442-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty