Healthcare Provider Details

I. General information

NPI: 1093079634
Provider Name (Legal Business Name): LAUREL KATHERINE BERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREL KATHERINE SANDERS

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-2868
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2014-02254
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40587
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number2014-02254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: