Healthcare Provider Details

I. General information

NPI: 1154688455
Provider Name (Legal Business Name): MARY WINDHAM LENFESTEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH WINDHAM M.D.

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-2335
  • Fax: 252-744-3811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123430
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number2018-00992
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018-00992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: