Lake Norman Neurology PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

LAKE NORMAN NEUROLOGY PA

Practice address

124 Professional Park Dr
Suite a
Mooresville, NC 28117-5537

Phone

(704) 662-3077

Fax

(704) 662-3458

NPI assigned

May 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Michele M Dufore

Title

Office Manager

Phone

(704) 662-3077

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Craig Daniel Dubois, M.D.

  • Neurology Physician
  • Mooresville, NC
  • NPI 1164414819
  NPD
• Bridgette Ann Cooke, PA-C

  • Physician Assistant
  • Statesville, NC
  • NPI 1023504735
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1356399554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 PROFESSIONAL PARK DR",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175537",
            "telephone_number": "704-662-3077",
            "fax_number": "704-662-3458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 PROFESSIONAL PARK DR",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175537",
            "telephone_number": "704-662-3077",
            "fax_number": "704-662-3458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN NEUROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "DUFORE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "704-662-3077",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013KP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Norman Inpatient Specialists
• Lake Norman Integrative Psychiatry
• Lake Norman Muay Thai LLC
• Lake Norman Neurological and Spinal Surgery, P.a.
• Lake Norman Neurology
• Lake Norman OBGYN LLP
• Lake Norman Ophthalmology PLLC
• Lake Norman Pain and Weight Management, LLC
• Lake Norman Pediatrics, PA
• Lake Norman Plastic Surgery

• Neurology Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Neurology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.