Provider Demographics
NPI:1407834278
Name:PEELE, LORI DIANE (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DIANE
Last Name:PEELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10224 DURANT RD STE 209
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6468
Mailing Address - Country:US
Mailing Address - Phone:919-322-8255
Mailing Address - Fax:833-972-5896
Practice Address - Street 1:10224 DURANT RD STE 209
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6468
Practice Address - Country:US
Practice Address - Phone:919-322-8255
Practice Address - Fax:919-646-9674
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01169207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCN192AMedicare PIN
NCNCN192F607Medicare PIN
NC5901696Medicaid
NC2005-01169OtherNC MEDICAL LICENSE #
NCI39601Medicare UPIN
NCNCN192AMedicare PIN
NCNC3450CMedicare PIN
NC183115OtherMEDCOST LLC PROVIDER #
NC184329OtherANTHEM SERVICES #