MEDICARE: DR. LYDIA APPIAH-DWAMENA MD

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
1	207V00000X	Obstetrics & Gynecology Physician	L7963	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255307120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYDIA APPIAH-DWAMENA MD

Provider Business Mailing Address
First Line	:	102 PALO ALTO RD
Second Line	:	SUITE 230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-3758
Country	:	US
Telephone Number	:	210-922-3331
Fax Number	:	210-922-3339

Provider Business Practice Location Address
First Line	:	102 PALO ALTO RD
Second Line	:	SUITE 230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-3758
Country	:	US
Telephone Number	:	210-922-3331
Fax Number	:	210-922-3339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	09/04/2012

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