Provider Demographics
NPI:1104879360
Name:URRUTIA, MARIBEL L (MD)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:L
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:U
Other - Last Name:LOCKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 E MOREHEAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E MOREHEAD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2742
Practice Address - Country:US
Practice Address - Phone:704-334-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME766872085R0202X
NC2025-017492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904527CMedicaid
FL258979600Medicaid
GA000904527DMedicaid
GA000904527AMedicaid
FL35747OtherBCBS
300117834Medicare PIN
FL35747YMedicare PIN
GA000904527DMedicaid
GA000904527CMedicaid
300117833Medicare PIN
FL35747OtherBCBS