Provider Demographics
NPI:1225008436
Name:LAKE NORMAN OBGYN LLP
Entity Type:Organization
Organization Name:LAKE NORMAN OBGYN LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR ADMINISTRATIVE PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-663-1282
Mailing Address - Street 1:131 MEDICAL PARK RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-663-1282
Mailing Address - Fax:704-663-1413
Practice Address - Street 1:131 MEDICAL PARK RD
Practice Address - Street 2:STE 102
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-663-1282
Practice Address - Fax:704-663-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty