MEDICARE: MS. GAIL ELIZABETH LYDON RN MS CS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	133541	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	494280	OTHER	TUFTS
2	70010000	OTHER	BCBS
3	137934000	OTHER	MAGELLAN
4	PN0069	OTHER	BCBS

General Provider Information

NPI Number	:	1568527968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL ELIZABETH LYDON RN MS CS

Provider Business Mailing Address
First Line	:	25 MAIN STREET
Second Line	:	SUITE 7
City	:	WAYLAND
State	:	MA
Zip	:	01778-5036
Country	:	US
Telephone Number	:	781-641-3700
Fax Number	:	508-655-1270

Provider Business Practice Location Address
First Line	:	25 MAIN STREET
Second Line	:	SUITE 7
City	:	WAYLAND
State	:	MA
Zip	:	01778-5036
Country	:	US
Telephone Number	:	781-641-3700
Fax Number	:	508-655-1270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	09/04/2011

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