Provider Demographics
NPI:1306039185
Name:LAWRENCE M LINETT, MD, PLLC
Entity Type:Organization
Organization Name:LAWRENCE M LINETT, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-791-2788
Mailing Address - Street 1:2595 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7748
Mailing Address - Country:US
Mailing Address - Phone:910-791-2788
Mailing Address - Fax:910-791-2711
Practice Address - Street 1:4501 MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4589
Practice Address - Country:US
Practice Address - Phone:910-754-9000
Practice Address - Fax:910-754-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52071207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC52071OtherBC/BS
NCC82218Medicare UPIN