Provider Demographics
NPI:1942382940
Name:NICKERSON, LLOYD EMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:EMERY
Last Name:NICKERSON
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 1:1811 E INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6030
Mailing Address - Country:US
Mailing Address - Phone:704-216-8777
Mailing Address - Fax:704-638-3129
Practice Address - Street 1:1811 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6030
Practice Address - Country:US
Practice Address - Phone:704-216-8777
Practice Address - Fax:704-638-3129
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0138ROtherBLUECROSS GROUP ID
NC28472OtherMAMSI ID
NC8962644Medicaid
NC01-41632OtherUNITED HEALTHCARE
NC202595OtherBLACK LUNG ID
NC62644OtherBCBS PERSONAL ID
NC1942382940Medicaid
NC38151OtherSTATE LICENSE
NC561794820OtherPRUDENTIAL ID
NC890138RMedicaid
NC3926OtherPARTNERS ID
NC2723OtherHEALTHSOURCE
NC561794820OtherAETNA US HEALTHCARE
NC561794820OtherCIGNA ID #
NC561794820OtherCIGNA ID #
NC010025945Medicare PIN
NC28472OtherMAMSI ID
NC38151OtherSTATE LICENSE
NCC95292Medicare UPIN
NC8962644Medicaid
NC2311063Medicare PIN
NC561794820OtherCIGNA ID #