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Individual
LYDIA CHARLES
Active
Individual
LYDIA CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MA06235800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA06235800
MEDICAL LICENSE
NJ
Enumeration date
10/21/2005
Last updated
11/12/2013
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