Provider Demographics
NPI:1881825495
Name:JOHN P LYDON DPM
Entity Type:Organization
Organization Name:JOHN P LYDON DPM
Other - Org Name:BETHESDA AMBULATORY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LYDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-530-4181
Mailing Address - Street 1:5620 SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3532
Mailing Address - Country:US
Mailing Address - Phone:301-530-4181
Mailing Address - Fax:301-530-4373
Practice Address - Street 1:5620 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3532
Practice Address - Country:US
Practice Address - Phone:301-530-4181
Practice Address - Fax:301-530-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1170261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD310831Medicare PIN