Provider Demographics
NPI:1508520388
Name:PELUSO, LYDIA JOY (PA-C)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:JOY
Last Name:PELUSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:JOY
Other - Last Name:POLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2827 TELEK PL APT 1617
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4865
Mailing Address - Country:US
Mailing Address - Phone:724-712-6964
Mailing Address - Fax:
Practice Address - Street 1:4141 W WILSON RD BLDG 1600
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-5162
Practice Address - Country:US
Practice Address - Phone:240-298-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant