Provider Demographics
NPI:1770557605
Name:LAW, MICHAEL MORRIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MORRIS
Last Name:LAW
Suffix:
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 1:10941 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6487
Mailing Address - Country:US
Mailing Address - Phone:919-256-0900
Mailing Address - Fax:
Practice Address - Street 1:10941 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6487
Practice Address - Country:US
Practice Address - Phone:919-256-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2000-00871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133NYMedicaid
NCF12231Medicare UPIN
NC89133NYMedicaid
NC2335052Medicare ID - Type UnspecifiedGROUP NUMBER