Provider Demographics
NPI:1801080460
Name:PALMER, LENA BRICE (MD)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:BRICE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2160 S. 1ST AVENUE
Mailing Address - Street 2:BUILDING 54, ROOM 167
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:919-966-4996
Mailing Address - Fax:919-843-5515
Practice Address - Street 1:2160 S. 1ST AVENUE
Practice Address - Street 2:BUILDING 54, ROOM 167
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-0464
Practice Address - Fax:701-216-4113
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200701318207RG0100X
IL036128566207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology