Healthcare Provider Details

I. General information

NPI: 1619951605
Provider Name (Legal Business Name): WILLIAM BEALL LORENTZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

PO BOX 344
WINSTON SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax:
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number16656
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number0101018856
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier27224
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDCOST
# 2
Identifier191607000
Identifier TypeMEDICAID
Identifier StateWV
Identifier Issuer
# 3
IdentifierQ16656
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 4
Identifier7310404
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 5
Identifier4533132
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 6
Identifier52915
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS
# 7
Identifier8952915
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 8
Identifier2679
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerPARTNERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: