Provider Demographics
NPI:1215912050
Name:ANNIS, CORY LYN (MD)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:LYN
Last Name:ANNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:127 FIDELITY ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2002
Mailing Address - Country:US
Mailing Address - Phone:919-933-8381
Mailing Address - Fax:919-933-6623
Practice Address - Street 1:127 FIDELITY ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2002
Practice Address - Country:US
Practice Address - Phone:919-933-8381
Practice Address - Fax:919-933-6623
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401117207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91928OtherMEDCOST INSURANCE
NC8911319Medicaid
NC11319OtherBLUE CROSS & BLUE SHIELD
NC370016487OtherRAILROAD MEDICARE
NC370016487OtherRAILROAD MEDICARE
NC91928OtherMEDCOST INSURANCE