Healthcare Provider Details

I. General information

NPI: 1215932140
Provider Name (Legal Business Name): MARY KATHERINE LAWRENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MEDICAL PARK CT
MOREHEAD CITY NC
28557-4346
US

IV. Provider business mailing address

302 MEDICAL PARK CT
MOREHEAD CITY NC
28557-4346
US

V. Phone/Fax

Practice location:
  • Phone: 252-247-2013
  • Fax: 252-247-7299
Mailing address:
  • Phone: 252-247-2013
  • Fax: 252-247-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number30397
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: