Provider Demographics
NPI:1558319368
Name:DESPORTES, LUCY YARBROUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:YARBROUGH
Last Name:DESPORTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01207207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901831Medicaid
SC773936OtherWELLCARE
NC7921752OtherAETNA
SC000000296463OtherUNISON HEALTH PLAN OF SC
NCBCBSOther141GE
SC01152109OtherAMERIGROUP OF SC
NC182378OtherMEDCOST
P0027725OtherRAILROAD MEDICARE
773936OtherWELLCARE
NC806943OtherCOMMUNITY EYE CARE
NC32675OtherCIGNA/OPTICARE
SCN07005Medicaid
NC5823186OtherCIGNA HEALTHCARE
SC20096154OtherSELECT HEALTH OF SC
SCN07005Medicaid
NC5901831Medicaid
2043351Medicare PIN
SC000000296463OtherUNISON HEALTH PLAN OF SC