Provider Demographics
NPI:1083738629
Name:LAYMAN, PAUL (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LAYMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 DANIEL RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-7151
Practice Address - Country:US
Practice Address - Phone:828-286-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103403363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101807Medicaid
NC1083738629Medicaid
NCML0882678OtherDEA#
SC2285PAMedicaid
NC103403OtherNC LICENSE #
NCNC1776GMedicare UPIN
NCNC1776HMedicare UPIN
NC1776LMedicare UPIN
NCNC1776EMedicare UPIN
NCNC1776FMedicare UPIN
NCNC1776KMedicare UPIN
NCNC1776MMedicare UPIN
NC1083738629Medicaid
NCNC1776BMedicare UPIN
NCNC1776JMedicare UPIN
NCP67301Medicare UPIN
NCNC1776AMedicare PIN
NCML0882678OtherDEA#
SC2285PAMedicaid
NCNC1776CMedicare UPIN
NCNC1776OMedicare UPIN
NCNC1776PMedicare UPIN
NC8101807Medicaid
NCNC1776QMedicare PIN