Provider Demographics
NPI:1831282037
Name:KNOTT, LAWRENCE HARDING JR (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HARDING
Last Name:KNOTT
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 1:1411 PHYSICIANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-343-0811
Mailing Address - Fax:910-343-5719
Practice Address - Street 1:1411 PHYSICIANS DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-343-0811
Practice Address - Fax:910-343-5719
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-06-12
Deactivation Date:2011-11-07
Deactivation Code:
Reactivation Date:2012-06-12
Provider Licenses
StateLicense IDTaxonomies
NC180102086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020009411OtherRAILROAD MEDICARE INDV. #
NC89-49778Medicaid
NC49778OtherBCBS OF NC INDV.#
NC1409884OtherINDV. UNITED HEALTHCARE #
NC1409884OtherINDV. UNITED HEALTHCARE #
NC49778OtherBCBS OF NC INDV.#