Provider Demographics
NPI:1467705483
Name:BOYD CAMPBELL, LYDIA ELAINE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:ELAINE
Last Name:BOYD CAMPBELL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 DUN LORING DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9021
Mailing Address - Country:US
Mailing Address - Phone:919-427-5097
Mailing Address - Fax:
Practice Address - Street 1:1980 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-229-8010
Practice Address - Fax:919-229-8009
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFA6563Medicare UPIN