Provider Demographics
NPI:1912097288
Name:LAMB, DOUGLAS LAWRENCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LAWRENCE
Last Name:LAMB
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:397 MASONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-7030
Mailing Address - Country:US
Mailing Address - Phone:252-728-5737
Mailing Address - Fax:252-728-5739
Practice Address - Street 1:1620 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1581
Practice Address - Country:US
Practice Address - Phone:252-728-5737
Practice Address - Fax:252-728-5739
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2023-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P92750Medicare UPIN