Provider Demographics
NPI:1053525782
Name:MCNEARY, LYDIA L (MD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:L
Last Name:MCNEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 SANFORD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1122
Mailing Address - Country:US
Mailing Address - Phone:540-200-8996
Mailing Address - Fax:540-215-5948
Practice Address - Street 1:2311 SANFORD AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1122
Practice Address - Country:US
Practice Address - Phone:540-200-8996
Practice Address - Fax:540-215-5948
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245548208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053525782Medicaid
VA020007C19OtherMEDICARE PTAN