Provider Demographics
NPI:1609927078
Name:LAKE NORMAN SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:LAKE NORMAN SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-664-5100
Mailing Address - Street 1:131 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8522
Mailing Address - Country:US
Mailing Address - Phone:704-664-5100
Mailing Address - Fax:704-664-5328
Practice Address - Street 1:131 MEDICAL PARK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8522
Practice Address - Country:US
Practice Address - Phone:704-664-5100
Practice Address - Fax:704-664-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCG38464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2176396BMedicare ID - Type Unspecified
NCF41915Medicare UPIN