Provider Demographics
NPI:1770501025
Name:WILLIAMS, LARAMIE A (MD)
Entity Type:Individual
Prefix:
First Name:LARAMIE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
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 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-512-2610
Mailing Address - Fax:704-543-6773
Practice Address - Street 1:7800 PROVIDENCE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2952
Practice Address - Country:US
Practice Address - Phone:704-512-2610
Practice Address - Fax:704-543-6773
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC87704OtherBCBS
SCN39499Medicaid
NC8987704Medicaid
NC2007056OtherAETNA
NCF54150Medicare UPIN