Provider Demographics
NPI:1114268232
Name:GEORGY, LYDIA
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:GEORGY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9032 ROSEWALL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2192
Mailing Address - Country:US
Mailing Address - Phone:703-303-6647
Mailing Address - Fax:
Practice Address - Street 1:9032 ROSEWALL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-303-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000765183500000X
VA0202206860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist