Provider Demographics
NPI:1770087959
Name:DAVIS, LYDIA (DO)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8591 HOLLY MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-8604
Mailing Address - Country:US
Mailing Address - Phone:304-478-3339
Mailing Address - Fax:304-478-3311
Practice Address - Street 1:8591 HOLLY MEADOWS RD
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-8604
Practice Address - Country:US
Practice Address - Phone:304-478-3339
Practice Address - Fax:304-478-3311
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3797207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program