Provider Demographics
NPI:1700868890
Name:FUSCO, LAWRENCE J (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:FUSCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5450
Mailing Address - Country:US
Mailing Address - Phone:336-349-5040
Mailing Address - Fax:336-369-5366
Practice Address - Street 1:1818 RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5451
Practice Address - Country:US
Practice Address - Phone:336-349-5040
Practice Address - Fax:336-369-5366
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9701362207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891082FMedicaid
NCE34307Medicare UPIN
NC891082FMedicaid