1649258617 NPI number — DR. MARCI E LAIT MD

Table of content: DR. MARCI E LAIT MD (NPI 1649258617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649258617 NPI number — DR. MARCI E LAIT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAIT
Provider First Name:
MARCI
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649258617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4917 S CROATAN HWY STE 1C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAGS HEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27959-8996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-489-4682
Provider Business Mailing Address Fax Number:
252-715-2007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4917 S CROATAN HWY STE 1C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAGS HEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27959-8996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-489-4682
Provider Business Practice Location Address Fax Number:
252-715-2007
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  209643 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 2007-01728 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0139611 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0139611 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04 2472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7956314 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA3713 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: J23431 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04 2472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60884 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784045 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10 00121 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1496762 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040016008 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A32301 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: J23431 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: J23431 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "HEALTHCARE VALUE MANAGEME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1919737 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".




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