Healthcare Provider Details

I. General information

NPI: 1497075659
Provider Name (Legal Business Name): LORENA ROCHA WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORENA ROCHA PEREIRA MD

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SANGRE DE CRISTO DR
DURHAM NC
27705-2872
US

IV. Provider business mailing address

19 SANGRE DE CRISTO DR
DURHAM NC
27705-2872
US

V. Phone/Fax

Practice location:
  • Phone: 770-653-3691
  • Fax:
Mailing address:
  • Phone: 770-653-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2013-00679
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: