Healthcare Provider Details

I. General information

NPI: 1609946607
Provider Name (Legal Business Name): IRLENE LOCKLEAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

IV. Provider business mailing address

1201 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-4733
  • Fax: 910-323-2097
Mailing address:
  • Phone: 910-323-4733
  • Fax: 910-323-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number9900588
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9900588
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: