| Lld Laboratories, Llc | |
|
249 E Nc Highway 54 Suite 310 Durham NC 27713-7512 | |
| (919) 753-1080 | |
| (919) 753-1089 |
| Full Name | Lld Laboratories, Llc |
|---|---|
| Speciality | Clinical Medical Laboratory |
| Location | 249 E Nc Highway 54, Durham, North Carolina |
| Authorized Official Name and Position | Lauren E Durant (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9197531080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lld Laboratories, Llc 249 E Nc Highway 54 Suite 310 Durham NC 27713-7512 Ph: (919) 753-1080 | Lld Laboratories, Llc 249 E Nc Highway 54 Suite 310 Durham NC 27713-7512 Ph: (919) 753-1080 |
| NPI Number | 1295196780 |
|---|---|
| Provider Enumeration Date | 03/11/2016 |
| Last Update Date | 03/15/2016 |
| Medicare PECOS PAC ID | 4981992468 |
|---|---|
| Medicare Enrollment ID | O20161017001302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295196780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Primary |
| Provider Name | Jennifer A Hanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235249533 PECOS PAC ID: 8224926951 Enrollment ID: I20040305000332 |
| Provider Name | William Thomas Trost |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528025822 PECOS PAC ID: 6002829736 Enrollment ID: I20060726000035 |
| Provider Name | Camille M Henry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922173640 PECOS PAC ID: 2365344504 Enrollment ID: I20070623000108 |
| Provider Name | Lorraine L Waguespack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689609976 PECOS PAC ID: 2769451954 Enrollment ID: I20071107000756 |
| Provider Name | Haresh Md Tharwani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790869618 PECOS PAC ID: 5496843088 Enrollment ID: I20071115000214 |
| Provider Name | Dionne Dillon Harrison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578755922 PECOS PAC ID: 7113002593 Enrollment ID: I20080310000327 |
| Provider Name | Lauren E Durant |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447333695 PECOS PAC ID: 0941354286 Enrollment ID: I20090820000426 |
| Provider Name | Sonja Falicia White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962702480 PECOS PAC ID: 2466630744 Enrollment ID: I20110711000518 |
| Provider Name | Lance R Fuller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720272073 PECOS PAC ID: 6709192016 Enrollment ID: I20150901003137 |
| Provider Name | Vincent Izediuno |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396078549 PECOS PAC ID: 6103083647 Enrollment ID: I20161214001439 |
| Provider Name | Clifford Harold Schilke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063524510 PECOS PAC ID: 4082668165 Enrollment ID: I20170131001782 |
| Provider Name | Tamara Litquinnie Mangum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770094179 PECOS PAC ID: 7618234493 Enrollment ID: I20171204000946 |
| Provider Name | Diana E Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992257232 PECOS PAC ID: 1658651906 Enrollment ID: I20180418000364 |
| Provider Name | Elzona Mae Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063843340 PECOS PAC ID: 8325381395 Enrollment ID: I20190514001597 |
| Provider Name | Denise Michel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700076627 PECOS PAC ID: 6305985516 Enrollment ID: I20190917001752 |
| Provider Name | Kavithamani Mallan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891257903 PECOS PAC ID: 1658602404 Enrollment ID: I20191009003209 |
| Provider Name | Glory S Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891393856 PECOS PAC ID: 7618389511 Enrollment ID: I20201217002776 |
| Provider Name | Susan Dumire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285230169 PECOS PAC ID: 4587064837 Enrollment ID: I20210608003724 |
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