Provider Demographics
NPI:1528040375
Name:LYMAN, GREGORY E (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:LYMAN
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 E MEDICAL LN STE 300
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4848
Practice Address - Country:US
Practice Address - Phone:803-936-8100
Practice Address - Fax:803-936-8130
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18131207V00000X
SC11401207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
730-10193OtherBLUE CROSS OF AL
P00041393OtherRAILROAD MEDICARE
MS01550224Medicaid
AL009924445Medicaid
160000582Medicare ID - Type Unspecified
AL009924445Medicaid