Basic Information
Provider Information | |||||||||
NPI: | 1023312733 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAUGHLIN | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | STEPHEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 602373 | ||||||||
Address2: |   | ||||||||
City: | CHARLOTTE | ||||||||
State: | NC | ||||||||
PostalCode: | 282602373 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282131500 | ||||||||
FaxNumber: | 8286516570 | ||||||||
Practice Location | |||||||||
Address1: | 260 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | BREVARD | ||||||||
State: | NC | ||||||||
PostalCode: | 287123378 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8288835330 | ||||||||
FaxNumber: | 8288835242 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/10/2011 | ||||||||
LastUpdateDate: | 12/20/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0010-02710 | NC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 0010-02710 | NC | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | NC5912B | 01 | NC | MEDICARE PTAN | OTHER | NC5912C | 01 | NC | MEDICARE PTAN | OTHER |