Individual
IRINA A LIDOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
124 SLADE AVE STE 210, PIKESVILLE, MD 21208
(443) 901-2040
(443) 901-2043
Mailing address
8110 MAPLE LAWN BLVD STE 235, FULTON, MD 20759-2694
(301) 340-8339
(301) 340-9027
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R149500
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R149500
STATE LICENSE
MD
Enumeration date
03/03/2006
Last updated
03/07/2023
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