MEDICARE: LAURINDA L QUEEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	26582	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538275482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURINDA L QUEEN MD

Provider Business Mailing Address
First Line	:	3921 SUNSET RIDGE RD
Second Line	:	SUITE 202
City	:	RALEIGH
State	:	NC
Zip	:	27607-6449
Country	:	US
Telephone Number	:	919-783-7877
Fax Number	:	919-783-8042

Provider Business Practice Location Address
First Line	:	3921 SUNSET RIDGE RD
Second Line	:	SUITE 202
City	:	RALEIGH
State	:	NC
Zip	:	27607-6449
Country	:	US
Telephone Number	:	919-783-7877
Fax Number	:	919-783-8042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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