Provider Demographics
NPI:1760494975
Name:SCHRADER, LYDIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:L
Last Name:SCHRADER
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:PO BOX 7555
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-7555
Mailing Address - Country:US
Mailing Address - Phone:530-893-6984
Mailing Address - Fax:530-893-6984
Practice Address - Street 1:251 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2241
Practice Address - Country:US
Practice Address - Phone:530-332-4530
Practice Address - Fax:530-893-6984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76606208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF81345Medicare UPIN
CAZZZ23307ZMedicare ID - Type Unspecified