Provider Demographics
NPI:1275038168
Name:BRESKIN, LYDIA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANNE
Last Name:BRESKIN
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 1:3009 IBERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5419
Mailing Address - Country:US
Mailing Address - Phone:313-727-8851
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3020
Practice Address - Country:US
Practice Address - Phone:504-503-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA323553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program