Provider Demographics
NPI:1134142391
Name:HORNE, LILLIAN RAE (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:RAE
Last Name:HORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:530 BLUESTONE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1955
Mailing Address - Country:US
Mailing Address - Phone:919-361-4766
Mailing Address - Fax:
Practice Address - Street 1:3301 TERMINAL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1997
Practice Address - Country:US
Practice Address - Phone:919-814-2727
Practice Address - Fax:800-213-4920
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC207383AMedicare ID - Type Unspecified
NCC84579Medicare UPIN