Provider Demographics
NPI:1114997285
Name:NYCUM, LAWRENCE
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:NYCUM
Suffix:
Gender:M
Credentials:
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 75216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0216
Mailing Address - Country:US
Mailing Address - Phone:336-718-7080
Mailing Address - Fax:336-718-9622
Practice Address - Street 1:1010 BETHESDA CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3019
Practice Address - Country:US
Practice Address - Phone:336-277-8800
Practice Address - Fax:336-277-8850
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501622207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0700782OtherUNITED HEALTHCARE
NC800220OtherPARTNERS NATIONAL HEALTH
3098889OtherAETNA HMO
NC132A9OtherBLUE CROSS BLUE SHIELD
B8416OtherMEDCOST
VA006005560Medicaid
7627370OtherAETNA PPO
NC89132A9Medicaid
P00031287OtherRAILROAD MEDICARE
P00031287OtherRAILROAD MEDICARE
H64985Medicare UPIN