Healthcare Provider Details

I. General information

NPI: 1598892234
Provider Name (Legal Business Name): LYDIA A MERLE M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL HERMANOS MELENDEZ, INC. APARTADO 306
BAYAMON PR
00960
US

IV. Provider business mailing address

3071 AVE ALEJANDRINO PMB 231
GUAYNABO PR
00969-7035
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-8494
  • Fax:
Mailing address:
  • Phone: 787-789-3220
  • Fax: 787-789-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9313
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: