1841238268 NPI number — CYNTHIA L LYDIARD

Table of content: (NPI 1841238268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841238268 NPI number — CYNTHIA L LYDIARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA L LYDIARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HELEN'S BRA CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841238268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 SUFFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGAWAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01001-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-786-3383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 SUFFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGAWAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01001-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-786-3383
Provider Business Practice Location Address Fax Number:
413-786-2388
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYDIARD
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
413-786-3383

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1540319 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4034826 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 734923 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 31283950001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 607765 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000393354 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003110856 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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