Kortum, Laurel Diane

Kortum, Laurel Diane is an individual health care provider with primary practice located at 3620 Joseph Siewick Dr Ste 202, Fairfax VA 22033-1756. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is her primary health care specialty. Kortum, Laurel Diane can be contacted via phone (703) 922-9501.

Contact Information

Primary practice address
3620 Joseph Siewick Dr Ste 202 Fairfax VA 22033-1756
Phone: (703) 922-9501
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X TEP4621 Nebraska
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 0101240278 Virginia

Profile Details

NPI number 1295773729
LBN Legal business name Kortum, Laurel Diane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2006
Last updated Mar 5th, 2015 - about 9 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 1295773729 NPPES
Virginia Other 484645 NCPPO
Virginia Other 033579 NCPPO
Virginia MEDICAID 1295773729 NCPPO
Virginia Other K142-0001 NCPPO
Virginia Other 9445356 NCPPO

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