Provider Demographics
NPI:1861476202
Name:SLAVISH, LYDIA G (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:G
Last Name:SLAVISH
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 1:915 OLD FERN HILL RD.
Mailing Address - Street 2:BLDG. D, SUITE 600
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-692-3434
Mailing Address - Fax:610-692-9005
Practice Address - Street 1:915 OLD FERN HILL RD.
Practice Address - Street 2:BLDG. D, SUITE 600
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-692-3434
Practice Address - Fax:610-692-9005
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044044E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012179160010Medicaid
PA2813313OtherAETNA
PA461735OtherBCBC
PA461735QWBMedicare ID - Type Unspecified
PA2813313OtherAETNA