Individual
DR. LYSLE KENNEDY AILSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 W ARLINGTON BLVD STE 210, GREENVILLE, NC 27834-5758
(252) 752-5000
(252) 931-7694
Mailing address
PO BOX 30750, GREENVILLE, NC 27833-0750
(252) 752-5000
(252) 931-7694
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
9600437
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10461
BCBSNC
NC
05
—
8910461
—
NC
Enumeration date
11/16/2005
Last updated
04/27/2022
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