Provider Demographics
NPI:1932461233
Name:YAMADA, LIDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:
Last Name:YAMADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIDIA
Other - Middle Name:BASTOS
Other - Last Name:CONFORTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 RESOLUTE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6608
Mailing Address - Country:US
Mailing Address - Phone:843-814-3722
Mailing Address - Fax:
Practice Address - Street 1:10 RESOLUTE LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6608
Practice Address - Country:US
Practice Address - Phone:843-814-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086582A2084N0400X
IL0361582882084N0400X
MO20210379672084N0400X
NC2021-027782084N0400X
SCLL 34536390200000X
SC345362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program