Provider Demographics
NPI:1023250669
Name:RECCHI, LAURA THERESE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:THERESE
Last Name:RECCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 GATEWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5608
Mailing Address - Country:US
Mailing Address - Phone:704-799-2878
Mailing Address - Fax:704-799-1627
Practice Address - Street 1:136 GATEWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5608
Practice Address - Country:US
Practice Address - Phone:704-799-2878
Practice Address - Fax:704-799-1627
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45399208000000X
NC2017-01792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201073410Medicaid
KY7100133010Medicaid
IN201073410Medicaid
KYK048901Medicare PIN