Provider Demographics
NPI:1568527968
Name:LYDON, GAIL ELIZABETH (RN MS CS)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ELIZABETH
Last Name:LYDON
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Gender:F
Credentials:RN MS CS
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Mailing Address - Street 1:25 MAIN STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-5036
Mailing Address - Country:US
Mailing Address - Phone:781-641-3700
Mailing Address - Fax:508-655-1270
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-5036
Practice Address - Country:US
Practice Address - Phone:781-641-3700
Practice Address - Fax:508-655-1270
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-09-04
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Provider Licenses
StateLicense IDTaxonomies
MA1335412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
494280OtherTUFTS
70010000OtherBCBS
137934000OtherMAGELLAN
PN0069OtherBCBS
N50271Medicare ID - Type Unspecified