Mary Fennell Lyles, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

22777 Issued in NC

Practice address

Medical Center Blvd
Winston Salem, NC 27157-0001

Phone

(336) 716-2255

NPI assigned

Dec 13, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1861477804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020344",
            "telephone_number": "336-716-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYLES",
        "first_name": "MARY",
        "middle_name": "FENNELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-13",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "22777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "27314",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011190",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "10656",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8953464",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "53464",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7449759",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7602715",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q22777",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Jane Lydon, MSW, LCSW
• Elizabeth Susan Lyerly, PA-C
• Mark Andrew Lyerly, MD
• Lyfes New Direction
• Earl Jr Lyles
• Lyn P. Carpenter, PH.D., PLLC
• Ashley Lynch
• Dennis John Lynch, PH.D.
• Kyle Anthony Lynch, MD
• Lindsay Jean Lynch, MD

• Geriatric Medicine (Internal Medicine) Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Geriatric Medicine (Internal Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.