Provider Demographics
NPI:1679634018
Name:MARTIN, LOIS BEARD (DO)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:BEARD
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 WRIGHTSVILLE AVE
Mailing Address - Street 2:SUITE B9
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7219
Mailing Address - Country:US
Mailing Address - Phone:910-509-4116
Mailing Address - Fax:910-509-7566
Practice Address - Street 1:7110 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE B9
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7219
Practice Address - Country:US
Practice Address - Phone:910-509-4116
Practice Address - Fax:910-509-7566
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600064207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0247ROtherBCBS
NC8954150Medicaid
NC0247ROtherBCBS
NC8954150Medicaid