Healthcare Provider Details

I. General information

NPI: 1912937079
Provider Name (Legal Business Name): LYDIA U PARKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/16/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 PARK EAST DR STE 109
BEACHWOOD OH
44122-4329
US

IV. Provider business mailing address

3737 PARK EAST DR STE 109
BEACHWOOD OH
44122-4329
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-7333
  • Fax: 216-464-2696
Mailing address:
  • Phone: 216-464-7333
  • Fax: 216-464-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35-058810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: