Provider Demographics
NPI:1467471292
Name:FLEISHMAN, LAWRENCE MARK (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MARK
Last Name:FLEISHMAN
Suffix:
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7030 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8298
Practice Address - Country:US
Practice Address - Phone:704-667-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8932527Medicaid
NC110212034OtherMEDICARE RAILROAD
SCN28972Medicaid
NC32527OtherBCBS
NC1467471292Medicaid
NCC83807Medicare UPIN
NC110212034OtherMEDICARE RAILROAD