Provider Demographics
NPI:1932191400
Name:BLAIR-BRITT, LORAY ANTOINETTE (MD)
Entity type:Individual
Prefix:MS
First Name:LORAY
Middle Name:ANTOINETTE
Last Name:BLAIR-BRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-719-6100
Mailing Address - Fax:336-719-2313
Practice Address - Street 1:865 WESTLAKE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2102
Practice Address - Country:US
Practice Address - Phone:336-719-6100
Practice Address - Fax:336-719-2313
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60233207Q00000X
NC2019-01882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058163100Medicaid
FLE49167Medicare UPIN
FL12681Medicare ID - Type Unspecified