Provider Demographics
NPI:1326277369
Name:VAN, LYDIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:T
Last Name:VAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5449 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1722
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-367-0929
Practice Address - Street 1:5449 S SEMORAN BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-367-0929
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2018-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0057186207Q00000X, 208M00000X
FLME111794208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist