Provider Demographics
NPI:1730324096
Name:DONOGHUE, LYDIA JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:JOY
Last Name:DONOGHUE
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 1:8234 JOHN R
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2506
Mailing Address - Country:US
Mailing Address - Phone:248-219-5620
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:DEPT OF PEDIATRIC SURGERY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-831-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350954542086S0120X
MI43010779772086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000674254OtherANTHEM
OH9244570OtherAETNA
OH07021OtherPARAMOUNT
OH3044351Medicaid
OH3044351Medicaid