Provider Demographics
NPI:1417902552
Name:RAINES, LAWRENCE MERIAL III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MERIAL
Last Name:RAINES
Suffix:III
Gender:M
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:P.O. BOX 3153
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-3153
Mailing Address - Country:US
Mailing Address - Phone:919-462-1558
Mailing Address - Fax:888-804-9673
Practice Address - Street 1:1220 S.E. MAYNARD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6944
Practice Address - Country:US
Practice Address - Phone:919-462-1558
Practice Address - Fax:888-804-9673
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401309174400000X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2238069GMedicare ID - Type Unspecified
NCG58355Medicare UPIN