LYDIA IVETTE VIDAL-CARDOZO PAC NPI 1174533863

NPI Information

NPI: 1174533863
Provider Name: LYDIA IVETTE VIDAL-CARDOZO, PAC
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
108 FINNEGAN CT
MYRTLE BEACH, SC
ZIP 29579
Phone: (843) 909-9993
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Lydia Ivette Vidal-cardozo, PAC is a medical physician assistant in Myrtle Beach, SC. Lydia Ivette Vidal-cardozo, PAC NPI is 1174533863. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

108 FINNEGAN CT
MYRTLE BEACH, SC
ZIP 29579-205
Phone: (843) 909-9993
Fax: (843) 903-3366

The enumeration date for this NPI number is 8/8/2006 and was last updated on 1/15/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		C0000746	MARYLAND	No
2	363AM0700X	Physician Assistant	Medical	PA1294	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	199L	MEDICARE ID-TYPE UNSPECIFIED
2	AA50828627	MEDICARE UPIN	SOUTH CAROLINA
3	8627	MEDICARE PIN	SOUTH CAROLINA
4	S71737	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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