Provider Demographics
NPI:1124006424
Name:BUBB, LORI C (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:C
Last Name:BUBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JULIAN LN
Mailing Address - Street 2:SUITE 630
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7813
Mailing Address - Country:US
Mailing Address - Phone:828-651-0121
Mailing Address - Fax:828-651-0141
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:SUITE 630
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7813
Practice Address - Country:US
Practice Address - Phone:828-651-0121
Practice Address - Fax:828-651-0141
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01569207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCP462AOtherMEDICARE-PALMETTO
NC5909551Medicaid
H70797Medicare UPIN