Provider Demographics
NPI:1215932140
Name:LAWRENCE, MARY KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:302 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4346
Mailing Address - Country:US
Mailing Address - Phone:252-247-2013
Mailing Address - Fax:252-247-7299
Practice Address - Street 1:302 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4346
Practice Address - Country:US
Practice Address - Phone:252-247-2013
Practice Address - Fax:252-247-7299
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30397207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCJ679A417Medicare PIN
C85082Medicare UPIN
NC51222OtherBCBS OF NC
NC2195692Medicare ID - Type UnspecifiedCIGNA MEDICARE