Provider Demographics
NPI:1912951815
Name:MORETZ, LAURA MELINDA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MELINDA
Last Name:MORETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MELINDA
Other - Last Name:MURRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-2717
Mailing Address - Country:US
Mailing Address - Phone:864-429-8029
Mailing Address - Fax:864-429-3515
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2717
Practice Address - Country:US
Practice Address - Phone:864-429-8029
Practice Address - Fax:864-429-3515
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110668Medicaid
SC8688Medicare PIN
SC5878670012Medicare NSC
B92340Medicare UPIN
SCB92340Medicare ID - Type Unspecified