Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 0101018856 | VA |
Y | 2080P0210X | Pediatric Nephrologist | 16656 | NC |
NPI | 1619951605 |
---|---|
Provider Name | William Beall Lorentz JR. |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
191607000 | (05) | WV |
2679 | PARTNERS (01) | NC |
27224 | MEDCOST (01) | NC |
4533132 | AETNA (01) | |
52915 | BCBS (01) | NC |
7310404 | (05) | VA |
8952915 | (05) | NC |
C85212 | (02) | |
Q16656 | (05) | SC |