Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 9501622 | NC |
NPI | 1114997285 |
---|---|
Provider Name | Dr. Lawrence Nycum |
First Address | Charlotte, NC 28275-0216 |
Second Address | Winston Salem, NC 27103-3019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006005560 | (05) | VA |
0700782 | UNITED HEALTHCARE (01) | |
132A9 | BLUE CROSS BLUE SHIELD (01) | NC |
3098889 | AETNA HMO (01) | |
7627370 | AETNA PPO (01) | |
800220 | PARTNERS NATIONAL HEALTH (01) | NC |
89132A9 | (05) | NC |
B8416 | MEDCOST (01) | |
H64985 | (02) | |
P00031287 | RAILROAD MEDICARE (01) |