Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 201801469 | NC |
NPI | 1639559883 |
---|---|
Provider Name | Dr. Lindly Theroux |
First Address | Winston Salem, NC 27101-3687 |
Second Address | Winston Salem, NC 27157-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 02/07/2019 |