Provider Demographics
NPI:1821068313
Name:BIRMINGHAM, LORRAINE FAITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:FAITH
Last Name:BIRMINGHAM
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 1:3400 EXECUTIVE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7476
Mailing Address - Country:US
Mailing Address - Phone:919-875-0504
Mailing Address - Fax:919-875-0905
Practice Address - Street 1:3400 EXECUTIVE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7476
Practice Address - Country:US
Practice Address - Phone:919-875-0504
Practice Address - Fax:919-875-0905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8915624Medicaid
NC2335640Medicare ID - Type Unspecified
NC8915624Medicaid