Healthcare Provider Details

I. General information

NPI: 1831282037
Provider Name (Legal Business Name): LAWRENCE HARDING KNOTT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date: 11/07/2011
Reactivation Date: 06/12/2012

III. Provider practice location address

1411 PHYSICIANS DRIVE
WILMINGTON NC
28401
US

IV. Provider business mailing address

1411 PHYSICIANS DRIVE
WILMINGTON NC
28401
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0811
  • Fax: 910-343-5719
Mailing address:
  • Phone: 910-343-0811
  • Fax: 910-343-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18010
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number18010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: