Provider Demographics
NPI:1245463405
Name:CORN, LYDIA GAY (MD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:GAY
Last Name:CORN
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 1:80 S TUTTLE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6344
Mailing Address - Country:US
Mailing Address - Phone:941-284-0068
Mailing Address - Fax:941-315-8515
Practice Address - Street 1:80 S TUTTLE AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:941-284-0068
Practice Address - Fax:941-315-8515
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine