Provider Demographics
NPI:1275656928
Name:HARPER, LAURIE WINCHESTER (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:WINCHESTER
Last Name:HARPER
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 1:208 FOUNDATION DR
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-9052
Mailing Address - Country:US
Mailing Address - Phone:304-544-8615
Mailing Address - Fax:
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-544-8615
Practice Address - Fax:304-766-5931
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40541207R00000X, 208000000X
WV18586207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0110539000Medicaid
OH2029263Medicaid
WV4237591Medicare PIN
P00621501Medicare PIN
WV0110539000Medicaid