Provider Demographics
NPI:1740300185
Name:LUPTON, LAURA L (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:LUPTON
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 602478
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2478
Mailing Address - Country:US
Mailing Address - Phone:704-863-9700
Mailing Address - Fax:704-548-0927
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 5002
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-9700
Practice Address - Fax:704-548-0927
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-01261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138CYMedicaid
SCN0126BMedicaid
NC2033093DMedicare PIN
NC2033093CMedicare PIN
NCI16862Medicare UPIN
NC2033093IMedicare PIN
NC2033093AMedicare PIN
SCN0126BMedicaid
NC2033093FMedicare PIN