Healthcare Provider Details

I. General information

NPI: 1952391575
Provider Name (Legal Business Name): JOHN PATRICK LYDON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12417 OCEAN GTWY STE A6
OCEAN CITY MD
21842-9521
US

IV. Provider business mailing address

10310 THIRTY KNOTS LN
BERLIN MD
21811-3406
US

V. Phone/Fax

Practice location:
  • Phone: 443-664-7253
  • Fax:
Mailing address:
  • Phone: 301-518-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPC333
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: