Provider Demographics
NPI:1639160146
Name:SWEET, LYDECKE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDECKE
Middle Name:B
Last Name:SWEET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-8135
Mailing Address - Fax:617-724-8010
Practice Address - Street 1:73 HIGH ST
Practice Address - Street 2:CHARLESTOWN HEALTHCARE CENTER
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3026
Practice Address - Country:US
Practice Address - Phone:617-724-8135
Practice Address - Fax:617-724-8010
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA212913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0183857Medicaid
MA212913OtherTUFTS HEALTH PLAN
MAJ24920OtherBCBS MA
MA212913OtherTUFTS HEALTH PLAN
MA0183857Medicaid