Provider Demographics
NPI:1538282645
Name:LUTHER, VERA PARKHURST (MD)
Entity Type:Individual
Prefix:DR
First Name:VERA
Middle Name:PARKHURST
Last Name:LUTHER
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-4507
Mailing Address - Fax:336-716-3825
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-3825
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1365TOtherBCBS
NC5906675Medicaid
SCQ0149AMedicaid
D5391OtherMEDCOST
WV3810000127Medicaid
804450OtherPARTNERS
VA1538282645Medicaid
9123081OtherAETNA
NC2028473AMedicare PIN