Provider Demographics
NPI:1063538585
Name:AUSTRIA, MARIA LOURDES C (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA LOURDES
Middle Name:C
Last Name:AUSTRIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:509 OLDE WATERFORD WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4125
Mailing Address - Country:US
Mailing Address - Phone:910-383-3883
Mailing Address - Fax:910-383-6802
Practice Address - Street 1:509 OLDE WATERFORD WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4125
Practice Address - Country:US
Practice Address - Phone:910-383-3883
Practice Address - Fax:910-383-6802
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100118208000000X
MDD0052377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128U5Medicaid
NC89128U5Medicaid