Provider Demographics
NPI:1841247210
Name:MARTIN, LAWRENCE W (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:MARTIN
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 1:30 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8707
Mailing Address - Country:US
Mailing Address - Phone:910-295-4400
Mailing Address - Fax:910-295-2810
Practice Address - Street 1:30 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8707
Practice Address - Country:US
Practice Address - Phone:910-295-4400
Practice Address - Fax:910-295-2810
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96004102085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954615Medicaid
NC54615OtherBCBS NC
NC8954615Medicaid
NC2224246Medicare PIN
NC2224246BMedicare PIN
NC2224246CMedicare PIN