Provider Demographics
NPI:1235286691
Name:FOX, LAURIE JUDITH (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JUDITH
Last Name:FOX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1821
Mailing Address - Country:US
Mailing Address - Phone:919-933-8494
Mailing Address - Fax:919-933-9201
Practice Address - Street 1:301 LLOYD STREET
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510
Practice Address - Country:US
Practice Address - Phone:919-942-8741
Practice Address - Fax:919-942-1473
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCOTH000Medicare UPIN
NCOTH000Medicare ID - Type Unspecified