Provider Demographics
NPI:1568448512
Name:LAUGHLIN, WALTER P (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:P
Last Name:LAUGHLIN
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 1:301 S CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5011
Mailing Address - Country:US
Mailing Address - Phone:910-259-5721
Mailing Address - Fax:910-259-6975
Practice Address - Street 1:3710 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6147
Practice Address - Country:US
Practice Address - Phone:910-452-1400
Practice Address - Fax:910-791-9626
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100723208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC183342OtherMEDCOST
NC12833OtherBCBS
NC01-00528OtherUNITED HEALTHCARE
NC183342OtherMEDCOST
NCF34528Medicare UPIN