Provider Demographics
NPI:1679763759
Name:LAWRENCE M LINETT MD PLLC
Entity type:Organization
Organization Name:LAWRENCE M LINETT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:LINETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-791-2788
Mailing Address - Street 1:2595 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7748
Mailing Address - Country:US
Mailing Address - Phone:910-791-2788
Mailing Address - Fax:910-791-2711
Practice Address - Street 1:2595 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7748
Practice Address - Country:US
Practice Address - Phone:910-791-2788
Practice Address - Fax:910-791-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29322207RS0010X
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910174Medicaid
NC8910174Medicaid
NCC82218Medicare UPIN