Provider Demographics
NPI:1538159967
Name:ANDERSON, LYNN BIVINS (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:BIVINS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-774-9000
Practice Address - Fax:336-774-9012
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38887207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
399488OtherMAMSI
C6627OtherMEDCOST
NC8911245Medicaid
11245OtherBLUE CROSS
6876678004OtherCIGNA
6876678004OtherCIGNA
NCE58257Medicare UPIN