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NPI Code Detail

MEDICARE: LYDIA ROBINSON , MSM, PA-C

MEDICARE: LYDIA ROBINSON , MSM, PA-C
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
1363A00000XPhysician Assistant14276052-1206UT
2363A00000XPhysician Assistant032614NY

General Provider Information

NPI Number : 1346929403
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA ROBINSON , MSM, PA-C
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 451 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2054
Country : US
Telephone Number : 718-245-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2023
Last Update Date : 05/19/2026

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