Provider Demographics
NPI:1982623294
Name:MILLER ANDERSON, LYDIA H (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:H
Last Name:MILLER ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ROSSBURN WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8343
Mailing Address - Country:US
Mailing Address - Phone:919-960-0019
Mailing Address - Fax:919-960-0019
Practice Address - Street 1:319 N GRAHAM HOPEDALE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2990
Practice Address - Country:US
Practice Address - Phone:336-513-4126
Practice Address - Fax:336-513-4203
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99009492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133HWMedicaid
NC2010892Medicare ID - Type Unspecified
NC89133HWMedicaid