Provider Demographics
NPI:1609313410
Name:LAKESHORE WOMEN'S SPECIALIST, PC
Entity Type:Organization
Organization Name:LAKESHORE WOMEN'S SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-334-0150
Mailing Address - Street 1:4020 WESTCHASE BLVD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3938
Mailing Address - Country:US
Mailing Address - Phone:919-334-0150
Mailing Address - Fax:
Practice Address - Street 1:235 MEDICAL PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8545
Practice Address - Country:US
Practice Address - Phone:704-658-9211
Practice Address - Fax:704-658-9224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UWH OF NORTH CAROLINA. LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty