MEDICARE: CAROL M LYDON AUD

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	231H00000X	Audiologist	6430	NC

General Provider Information

NPI Number	:	1518207281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL M LYDON AUD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-472-1300
Fax Number	:	336-472-1302

Provider Business Practice Location Address
First Line	:	1213 LEXINGTON AVE
Second Line	:
City	:	THOMASVILLE
State	:	NC
Zip	:	27360-3416
Country	:	US
Telephone Number	:	336-472-1300
Fax Number	:	336-472-1302

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

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	02/18/2013

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