Provider Demographics
NPI:1841267218
Name:LIDOW, IRINA A (CRNP)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:A
Last Name:LIDOW
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:124 SLADE AVE STE 210
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:443-901-2040
Practice Address - Fax:443-901-2043
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR149500363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR149500OtherSTATE LICENSE
MDML4396291OtherDEA CERTIFICATE