Provider Demographics
NPI:1538144274
Name:LAWRENCE, KERITH D (MD)
Entity Type:Individual
Prefix:DR
First Name:KERITH
Middle Name:D
Last Name:LAWRENCE
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 1:127 FIDELITY ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2002
Mailing Address - Country:US
Mailing Address - Phone:919-933-8381
Mailing Address - Fax:919-933-6623
Practice Address - Street 1:127 FIDELITY ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2002
Practice Address - Country:US
Practice Address - Phone:919-933-8381
Practice Address - Fax:919-933-6623
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000039207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC9713OtherMEDCOST INSURANCE
NC131TROtherBCBS OF NC
NC89131TRMedicaid
NCC9713OtherMEDCOST INSURANCE
NC89131TRMedicaid