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NPI Code Detail

MEDICARE: IRINA A LIDOW CRNP

MEDICARE: IRINA A LIDOW CRNP
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
1363LW0102XWomen's Health Nurse PractitionerR149500MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1R149500OTHERMDSTATE LICENSE

General Provider Information

NPI Number : 1841267218
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRINA A LIDOW CRNP
Provider Business Mailing Address
First Line : 8110 MAPLE LAWN BLVD STE 235
Second Line :
City : FULTON
State : MD
Zip : 20759-2694
Country : US
Telephone Number : 301-340-8339
Fax Number : 301-340-9027
Provider Business Practice Location Address
First Line : 124 SLADE AVE STE 210
Second Line :
City : PIKESVILLE
State : MD
Zip : 21208
Country : US
Telephone Number : 443-901-2040
Fax Number : 443-901-2043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2006
Last Update Date : 03/07/2023

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