Healthcare Provider Details

I. General information

NPI: 1326084732
Provider Name (Legal Business Name): JOSEPHINE H LAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE H LAKE MD

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 REESE BLVD WEST SUITE 150
HUNTERSVILLE NC
28078
US

IV. Provider business mailing address

LAKE INTERNAL MEDICINE AND PEDIATRICS, PLLC 13801 REESE BLVD WEST SUITE 150
HUNTERSVILLE NC
28078
US

V. Phone/Fax

Practice location:
  • Phone: 704-274-8006
  • Fax: 704-997-3058
Mailing address:
  • Phone: 704-274-8006
  • Fax: 704-997-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9800943
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9800943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: