Healthcare Provider Details

I. General information

NPI: 1447344692
Provider Name (Legal Business Name): LAURA ANN HASTINGS-WOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203
US

IV. Provider business mailing address

1800 CAMDEN RD STE 107-259
CHARLOTTE NC
28203-4690
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-1639
  • Fax:
Mailing address:
  • Phone: 240-566-1639
  • Fax: 770-701-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberG86027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: