Provider Demographics
NPI:1558446948
Name:JOHNSON, LAUREN PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PATRICIA
Last Name:JOHNSON
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:NCSU SHS
Mailing Address - Street 2:2815 CATES AVE; PO BOX 7304
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-7304
Mailing Address - Country:US
Mailing Address - Phone:919-515-2563
Mailing Address - Fax:188-897-2415
Practice Address - Street 1:NCSU SHS
Practice Address - Street 2:2815 CATES AVE
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-7304
Practice Address - Country:US
Practice Address - Phone:919-515-2563
Practice Address - Fax:188-897-2415
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101072207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG33829Medicare UPIN
NC2051060Medicare ID - Type Unspecified
NC5903051Medicare ID - Type Unspecified