Provider Demographics
NPI:1033156245
Name:MONROE, LANNY LEE JR (MD)
Entity type:Individual
Prefix:MR
First Name:LANNY
Middle Name:LEE
Last Name:MONROE
Suffix:JR
Gender:M
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-982-2683
Mailing Address - Fax:704-512-4838
Practice Address - Street 1:105 YADKIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3449
Practice Address - Country:US
Practice Address - Phone:704-982-2683
Practice Address - Fax:704-512-4838
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00501208000000X
NC200600501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00539702Medicaid
NC1033156245Medicaid
NC5904693Medicaid
I16184Medicare UPIN
370000421Medicare PIN
NC1033156245Medicaid
NC5904693Medicaid