Healthcare Provider Details

I. General information

NPI: 1962603597
Provider Name (Legal Business Name): JAMES STEPHEN LYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S SHARON AMITY RD
CHARLOTTE NC
28211-2975
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-8800
  • Fax: 704-384-8819
Mailing address:
  • Phone: 704-384-8800
  • Fax: 704-384-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010-00102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: