Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101245548 | VA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301083637 | MI |
NPI | 1053525782 |
---|---|
Provider Name | Lydia L Mcneary |
First Address | Roanoke, VA 24014-1111 |
Second Address | Roanoke, VA 24014-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020007C19 | MEDICARE PTAN (01) | VA |
1053525782 | (05) | VA |