Provider Demographics
NPI:1013409051
Name:LIM, IDA M (DPM)
Entity Type:Individual
Prefix:DR
First Name:IDA
Middle Name:M
Last Name:LIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:IDA
Other - Middle Name:M
Other - Last Name:ADLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:704-443-6250
Mailing Address - Fax:704-443-6279
Practice Address - Street 1:2030 WINDSOR RUN LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0054
Practice Address - Country:US
Practice Address - Phone:704-443-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC738213ES0103X, 213ES0131X, 213EP1101X
NMT-1873213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist