Provider Demographics
NPI:1750374997
Name:LLOYD, LAURA A (DPM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:LLOYD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3524
Mailing Address - Country:US
Mailing Address - Phone:252-946-0324
Mailing Address - Fax:252-948-0558
Practice Address - Street 1:403 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3524
Practice Address - Country:US
Practice Address - Phone:252-946-0324
Practice Address - Fax:252-948-0558
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210213E00000X
PASC002874L(INACTIVE)213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0806GOtherBLUECROSS
NC5147461OtherAETNA
NC480033103OtherMEDICARE RAILROAD
NC1633301OtherUNITED HEALTHCARE
NC890806GMedicaid
T64075Medicare UPIN
NC890806GMedicaid