Provider Demographics
NPI:1609946607
Name:LOCKLEAR, IRLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRLENE
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 WALTER REED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4437
Mailing Address - Country:US
Mailing Address - Phone:910-323-4733
Mailing Address - Fax:910-323-2097
Practice Address - Street 1:1201 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4437
Practice Address - Country:US
Practice Address - Phone:910-323-4733
Practice Address - Fax:910-323-2097
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900588207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0438746OtherUNITED HEALTHCARE
NC1205YOtherBLUE CROSS & BLUE SHIELD
NC891205YMedicaid
NCG58672Medicare UPIN
NC891205YMedicaid