Healthcare Provider Details

I. General information

NPI: 1649258617
Provider Name (Legal Business Name): MARCI E LAIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 S CROATAN HWY STE 1C
NAGS HEAD NC
27959-8996
US

IV. Provider business mailing address

4917 S CROATAN HWY STE 1C
NAGS HEAD NC
27959-8996
US

V. Phone/Fax

Practice location:
  • Phone: 252-489-4682
  • Fax: 252-715-2007
Mailing address:
  • Phone: 252-489-4682
  • Fax: 252-715-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number209643
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2007-01728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: