Provider Demographics
NPI:1770726044
Name:PEZZUTO, LAURA MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MAUREEN
Last Name:PEZZUTO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 CORAL VINE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2288
Mailing Address - Country:US
Mailing Address - Phone:717-739-9885
Mailing Address - Fax:
Practice Address - Street 1:2400 WAYNE MEMORIAL DR STE I
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1749
Practice Address - Country:US
Practice Address - Phone:919-587-3980
Practice Address - Fax:919-587-3981
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84939207V00000X
HIMD18617207V00000X
MS31903207V00000X
FLME139387207V00000X
GA97529207V00000X
NC2013-00666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1883Medicaid
NC1770726044Medicaid
NCNCD650AMedicare PIN