Provider Demographics
NPI:1497735831
Name:FREDERICK, LAURENCE DAVIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:DAVIS
Last Name:FREDERICK
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2808 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1600
Practice Address - Country:US
Practice Address - Phone:919-736-2157
Practice Address - Fax:919-580-0424
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC38943207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2149372Medicaid
NC8933844Medicaid
NC2149372Medicaid