Healthcare Provider Details

I. General information

NPI: 1669711990
Provider Name (Legal Business Name): LAUREN MARIE KUCIRKA SCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 OLD CLINIC BUILDING
CHAPEL HILL NC
27599-7516
US

IV. Provider business mailing address

2215 E PRATT ST
BALTIMORE MD
21231-2069
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1601
  • Fax: 919-966-6377
Mailing address:
  • Phone: 336-407-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2021-01017
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: