Provider Demographics
NPI:1366400913
Name:PEARSON, LAWRENCE H (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3420
Mailing Address - Country:US
Mailing Address - Phone:704-866-7576
Mailing Address - Fax:704-866-7576
Practice Address - Street 1:700 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-484-0464
Practice Address - Fax:704-482-0308
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24327207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC62126OtherMEDCOST
NC66460OtherBCBS
NC8966460Medicaid
SCN24327Medicaid
NC8966460Medicaid
NC203053Medicare PIN
NC66460OtherBCBS