Healthcare Provider Details

I. General information

NPI: 1518127810
Provider Name (Legal Business Name): LYDIA GEDMINTAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST ARTHRITIS CENTER
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST ARTHRITIS CENTER
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5325
  • Fax: 617-732-5766
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number244962
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: