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NPI Code Detail

MEDICARE: DR. PATRICK DONOVAN LYDEN M.D.

MEDICARE: DR. PATRICK DONOVAN LYDEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology PhysicianG48156CA

General Provider Information

NPI Number : 1215962113
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK DONOVAN LYDEN M.D.
Provider Business Mailing Address
First Line : PO BOX 31309
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-0309
Country : US
Telephone Number : 323-442-5710
Fax Number :
Provider Business Practice Location Address
First Line : 1520 SAN PABLO ST STE 3000
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-5315
Country : US
Telephone Number : 323-442-5710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 11/27/2023

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Directions to “ DR. PATRICK DONOVAN LYDEN M.D.” Practice Location

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