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Individual
DAVID J LYDON
Active
Individual
DAVID J LYDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0260
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002605
—
SC
01
—
SCE4665193
MEDICARE PIN
SC
01
—
SCE4666084
MEDICARE PIN
SC
01
—
SCE466J577
MEDICARE PIN
SC
Enumeration date
03/17/2006
Last updated
06/10/2020
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