Provider Demographics
NPI:1154512309
Name:ADAMS, LYDIA HEYEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:HEYEL
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:HEYEL
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202D MCGILL AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4615
Mailing Address - Country:US
Mailing Address - Phone:704-792-2242
Mailing Address - Fax:704-792-2252
Practice Address - Street 1:202D MCGILL AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4615
Practice Address - Country:US
Practice Address - Phone:704-792-2242
Practice Address - Fax:704-792-2252
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910393Medicaid
NC5910393Medicaid