Provider Demographics
NPI:1619951605
Name:LORENTZ, WILLIAM BEALL JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BEALL
Last Name:LORENTZ
Suffix:JR
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: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:336-716-2255
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC166562080P0210X
VA01010188562080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27224OtherMEDCOST
WV191607000Medicaid
SCQ16656Medicaid
VA7310404Medicaid
4533132OtherAETNA
NC52915OtherBCBS
NC8952915Medicaid
NC2679OtherPARTNERS
NC27224OtherMEDCOST
WV191607000Medicaid
4533132OtherAETNA
390008215Medicare PIN