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Individual

DR. LIDA EATEDALI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1111 EAST END BLVD, VAMC., WILKES BARRE, PA 18711
(570) 824-3521
Mailing address
306 INDIAN CREEK DR, WILKES WOOD, WILKES BARRE, PA 18702-7826
(570) 820-0465

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301084937
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4301084937
MD LICENSE
MI
Enumeration date
07/25/2006
Last updated
07/08/2007
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