Provider Demographics
NPI:1720033574
Name:DEGUEHERY, LINDSEY ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:ELLIOT
Last Name:DEGUEHERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 GLENDALE DR SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4402
Mailing Address - Country:US
Mailing Address - Phone:252-291-5864
Mailing Address - Fax:800-290-5015
Practice Address - Street 1:1812 GLENDALE DR SW
Practice Address - Street 2:SUITE A
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4402
Practice Address - Country:US
Practice Address - Phone:252-291-5864
Practice Address - Fax:800-290-5015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28018207RP1001X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28279OtherBCBS OF NC NUMBER
NC22907OtherMEDCOST NUMBER
NCCL2570OtherMEDICARE RAILROAD NUMBER
NC4851761OtherUNITED HEALTHCARE
NC7224358OtherAETNA
NC10156220OtherVOCATIONAL REHAB NUMBER
NC8928279Medicaid
NC4851761OtherUNITED HEALTHCARE
NCC87722Medicare UPIN