Lyles, Mary Fennell
Lyles, Mary Fennell is an individual health care provider with primary practice located at Medical Center Blvd , Winston Salem NC 27157-0001. She recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as her primary health care specialty. Lyles, Mary Fennell can be contacted via phone (336) 716-2255.Contact Information
Primary practice address
Medical Center Blvd
Winston Salem NC 27157-0001
Phone: (336) 716-2255
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 22777 | North Carolina |
Profile Details
| NPI number | 1861477804 |
|---|---|
| LBN Legal business name | Lyles, Mary Fennell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 13th, 2005 |
| Last updated | May 14th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861477804 | NPPES |
| North Carolina | Other | 27314 | MEDCOST |
| North Carolina | MEDICAID | 3810011190 | MEDCOST |
| North Carolina | Other | 10656 | MEDCOST |
| North Carolina | MEDICAID | 8953464 | MEDCOST |
| North Carolina | Other | 53464 | MEDCOST |
| North Carolina | Other | 7449759 | MEDCOST |
| North Carolina | MEDICAID | 7602715 | MEDCOST |
| North Carolina | MEDICAID | Q22777 | MEDCOST |
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