Provider Demographics
NPI:1447215900
Name:MYLES, SIDNEY L (MD)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:L
Last Name:MYLES
Suffix:
Gender:M
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:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1447
Mailing Address - Country:US
Mailing Address - Phone:828-325-0555
Mailing Address - Fax:828-267-7555
Practice Address - Street 1:929 15TH ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4161
Practice Address - Country:US
Practice Address - Phone:828-325-0555
Practice Address - Fax:828-267-7555
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501179207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
511804OtherMANAGED HEALTH NETWORK
NCP00839051OtherRAILROAD MEDICARE
NC140N5OtherBCBS
NC5901852Medicaid
600019014OtherMAGELLAN
NC5901852Medicaid
I42869Medicare UPIN