Provider Demographics
NPI:1962739326
Name:LORI OAKLEY COE, MD, PA
Entity type:Organization
Organization Name:LORI OAKLEY COE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER, PRACTITIONER (SOLE
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:OAKLEY
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-969-1185
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:1072 NORTH MAIN STREET
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052-0486
Mailing Address - Country:US
Mailing Address - Phone:336-591-3466
Mailing Address - Fax:
Practice Address - Street 1:1072 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-9312
Practice Address - Country:US
Practice Address - Phone:336-591-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2341781Medicare PIN