Provider Demographics
NPI:1215130885
Name:MARTINEZ, LAURA LEE RAYNOR (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE RAYNOR
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:RAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4991 LAKE BROOK DR STE 300
Mailing Address - Street 2:PEDIATRIX MEDICAL GROUO
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:WINCHESTER MEDICAL CENTER, NEONATAL ICU
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-7897
Practice Address - Fax:540-536-7843
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-014282080N0001X
VA01012554822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC160A1OtherBCBSNC
NC5915855Medicaid
NC160A1OtherBCBSNC