Provider Demographics
NPI:1285682989
Name:SURLES, LARA KESTER (MD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:KESTER
Last Name:SURLES
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 1:2450 EMERALD PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5784
Mailing Address - Country:US
Mailing Address - Phone:252-551-1066
Mailing Address - Fax:252-551-1067
Practice Address - Street 1:2450 EMERALD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5784
Practice Address - Country:US
Practice Address - Phone:252-551-1066
Practice Address - Fax:252-551-1067
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134JYMedicaid
NC89134JYMedicaid
NCH86407Medicare UPIN