Healthcare Provider Details

I. General information

NPI: 1568448512
Provider Name (Legal Business Name): WALTER P LAUGHLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SHIPYARD BLVD
WILMINGTON NC
28403-6147
US

IV. Provider business mailing address

301 S CAMPBELL ST
BURGAW NC
28425-5011
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-1400
  • Fax: 910-791-9626
Mailing address:
  • Phone: 910-259-5721
  • Fax: 910-259-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200100723
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number200100723
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: