Healthcare Provider Details

I. General information

NPI: 1942403704
Provider Name (Legal Business Name): NICHOLAS STEPHEN LAURORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 DENIM COURT
NEW BERN NC
28562-9217
US

IV. Provider business mailing address

3505 DENIM COURT
NEW BERN NC
28562-9217
US

V. Phone/Fax

Practice location:
  • Phone: 252-772-0373
  • Fax:
Mailing address:
  • Phone: 252-772-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA02355200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number92279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: