Provider Demographics
NPI:1538275482
Name:QUEEN, LAURINDA L (MD)
Entity type:Individual
Prefix:
First Name:LAURINDA
Middle Name:L
Last Name:QUEEN
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 1:3921 SUNSET RIDGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6449
Mailing Address - Country:US
Mailing Address - Phone:919-783-7877
Mailing Address - Fax:919-783-8042
Practice Address - Street 1:3921 SUNSET RIDGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6449
Practice Address - Country:US
Practice Address - Phone:919-783-7877
Practice Address - Fax:919-783-8042
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26582207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969569Medicaid
203349Medicare ID - Type Unspecified
C81799Medicare UPIN