Provider Demographics
NPI:1265696363
Name:LYDELL, CARMEN P (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:P
Last Name:LYDELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2400 PACIFIC AVE
Mailing Address - Street 2:#707
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1280
Mailing Address - Country:US
Mailing Address - Phone:415-568-8577
Mailing Address - Fax:
Practice Address - Street 1:UCSF DEPARTMENT OF RADIOLOGY 505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-476-8358
Practice Address - Fax:415-476-0616
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1048702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology