Provider Demographics
NPI:1952364705
Name:TYDINGS, ALBERT I (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:I
Last Name:TYDINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LAKEVIEW CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7513
Mailing Address - Country:US
Mailing Address - Phone:985-892-1111
Mailing Address - Fax:985-892-1116
Practice Address - Street 1:121 LAKEVIEW CIR
Practice Address - Street 2:SUITE C
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7513
Practice Address - Country:US
Practice Address - Phone:985-892-1111
Practice Address - Fax:985-892-1116
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10505207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300446Medicaid
LA1300446Medicaid
LA55598Medicare ID - Type Unspecified