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General NPI Number Information
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NPI Number | 1164554606
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Entity Type | Organization
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Legal Business Name | LAURINBURG ENT CLINIC PA
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1705 BERWICK DR # B
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City | LAURINBURG
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State | NC
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Zip | 28352-5523
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Country | US
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Telephone | 910-610-4368
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Fax | 910-610-4388
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Provider Business Mailing Address
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Address Line | 1705 BERWICK DR # B
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City | LAURINBURG
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State | NC
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Zip | 28352-5523
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Country | US
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Telephone | 910-610-4368
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Fax | 910-610-4388
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Authorized Official
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Title or Position | OWNER
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Name | MARK K LAVIGNE
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Credential | M.D.
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Telephone | 910-610-4368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 9400093
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License Number State | NC
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