Provider Demographics
NPI:1942824917
Name:PELTIER, LYDIA HILLIER (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:HILLIER
Last Name:PELTIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ANN
Other - Last Name:HILLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:18100 NE UNION HILL RD FL 2
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3330
Practice Address - Country:US
Practice Address - Phone:425-881-5437
Practice Address - Fax:425-947-4521
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61395873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2289679Medicaid