Healthcare Provider Details

I. General information

NPI: 1114268232
Provider Name (Legal Business Name): DR. LYDIA GEORGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9032 ROSEWALL CT
SPRINGFIELD VA
22152
US

IV. Provider business mailing address

9032 ROSEWALL CT
SPRINGFIELD VA
22152-2192
US

V. Phone/Fax

Practice location:
  • Phone: 703-303-6647
  • Fax:
Mailing address:
  • Phone: 703-303-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100000765
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: