Provider Demographics
NPI:1942618962
Name:CLEMENTS, LYDIA I (MD)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:I
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4701 OGLETOWN STANTON ROAD
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2055
Mailing Address - Country:US
Mailing Address - Phone:302-366-1200
Mailing Address - Fax:302-366-1700
Practice Address - Street 1:4701 OGLETOWN STANTON ROAD
Practice Address - Street 2:SUITE 3400
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2055
Practice Address - Country:US
Practice Address - Phone:302-366-1200
Practice Address - Fax:302-366-1700
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012645207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology