Provider Demographics
NPI:1003806522
Name:CRANE, LYDIA O (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:O
Last Name:CRANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-984-1333
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1220 N HIGHWAY A1A
Practice Address - Street 2:SUITE 147
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-2848
Practice Address - Country:US
Practice Address - Phone:321-984-1333
Practice Address - Fax:321-951-9127
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4150YOtherMEDICARE
FL260343800Medicaid
FL080158643OtherRR MEDICARE
H17854Medicare UPIN