Basic Information
| Provider Information | |||||||||
| NPI: | 1053525501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | LILLIAN | ||||||||
| MiddleName: | KIZER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751069 | ||||||||
| Address2: | ECU PHYSICIANS | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 521 MOYE BLVD | ||||||||
| Address2: | ECU PHYSICIANS, MOYE MEDICAL CENTER 2ND FLOOR | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278342849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527443229 | ||||||||
| FaxNumber: | 2527443924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 06/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101242828 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 0101242828 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 2011-00137 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 2011-00137 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5916975 | 05 | NC | MEDICAID | 1619J | 01 | NC | BCBSNC | OTHER |