Provider Demographics
NPI:1245897933
Name:FRY, LYDIA KATHRYN
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:KATHRYN
Last Name:FRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:KATHRYN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7755
Mailing Address - Country:US
Mailing Address - Phone:717-422-8994
Mailing Address - Fax:
Practice Address - Street 1:100 S HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-1499
Practice Address - Country:US
Practice Address - Phone:717-776-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004844363A00000X
PAMA060672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant