Provider Demographics
NPI:1902851199
Name:NADIMI, LIDA (MD)
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:NADIMI
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 1:1322 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1322 CLUB HOUSE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8073
Practice Address - Country:US
Practice Address - Phone:175-787-6000
Practice Address - Fax:175-787-6000
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238513207L00000X
CAA92035207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010186854Medicaid
CA1902851199OtherMEDICARE
NC5901493Medicaid
I40006Medicare UPIN
CA1902851199OtherMEDICARE