Provider Demographics
NPI:1639168875
Name:LEMLEY, DOUGLAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:LEMLEY
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 1:6112 LINDLEY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4979
Mailing Address - Country:US
Mailing Address - Phone:336-855-7553
Mailing Address - Fax:336-855-7553
Practice Address - Street 1:6112 LINDLEY WOODS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4979
Practice Address - Country:US
Practice Address - Phone:336-855-7553
Practice Address - Fax:336-855-7553
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1012357542085R0202X
FLME898822085R0202X
GA539322085R0202X
KY385302085R0202X, 207RR0500X
NC311642085R0202X, 207RR0500X
OH616232085R0202X
PAMD4232442085R0202X
WV214332085R0202X
SC318862085R0202X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951658Medicaid
KY000000546740OtherBCBS PROVIDER NUMBER
VA010183871Medicaid
SCQ31164Medicaid
KY7100043640Medicaid
MD222307400Medicaid
VA010183871Medicaid
NC8951658Medicaid
KY00151029Medicare PIN
KY7100043640Medicaid
KY00503004Medicare PIN
VAC85113Medicare UPIN
KY00151029Medicare PIN