Provider Demographics
NPI:1952412595
Name:LYON SMITH, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:LYON SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:157 HEALTH SERVICES RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-3000
Mailing Address - Country:US
Mailing Address - Phone:336-372-5641
Mailing Address - Fax:336-372-7793
Practice Address - Street 1:157 HEALTH SERVICES RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-3000
Practice Address - Country:US
Practice Address - Phone:336-372-5641
Practice Address - Fax:336-372-7793
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE14228Medicare UPIN
NC208399DMedicare ID - Type UnspecifiedMEDICARE NUMBER