Provider Demographics
NPI:1669711990
Name:KUCIRKA, LAUREN MARIE (SCM)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:KUCIRKA
Suffix:
Gender:F
Credentials:SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2069
Mailing Address - Country:US
Mailing Address - Phone:336-407-2350
Mailing Address - Fax:
Practice Address - Street 1:3010 OLD CLINIC BUILDING
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7516
Practice Address - Country:US
Practice Address - Phone:919-966-1601
Practice Address - Fax:919-966-6377
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01017207VM0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program