Provider Demographics
NPI:1982896148
Name:VERDE, LAURA FORNOS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:FORNOS
Last Name:VERDE
Suffix:
Gender:F
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:PO BOX 602381
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2381
Mailing Address - Country:US
Mailing Address - Phone:828-586-7451
Mailing Address - Fax:828-586-7453
Practice Address - Street 1:80 HEALTHCARE DR
Practice Address - Street 2:STE 201
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5126
Practice Address - Country:US
Practice Address - Phone:828-586-7451
Practice Address - Fax:828-586-7453
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701329207R00000X
NC2007-01329207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1618AMedicare PIN