Provider Demographics
NPI:1043396849
Name:BARTHOLOMEW, LYDIA (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNION ST
Mailing Address - Street 2:2 UNION BLDG SUITE 810
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2341
Mailing Address - Country:US
Mailing Address - Phone:206-701-8047
Mailing Address - Fax:
Practice Address - Street 1:601 UNION ST
Practice Address - Street 2:2 UNION BLDG SUITE 810
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2341
Practice Address - Country:US
Practice Address - Phone:206-701-8047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4326OtherINTERNAL ID-MOTOR VEHICLE ID
WA0230694OtherL&I
WA1043396849Medicaid
WA1043396849Medicaid
4326OtherINTERNAL ID-MOTOR VEHICLE ID