Provider Demographics
NPI:1154549236
Name:LYDIA APPIAH DWAMENA, MD PA
Entity type:Organization
Organization Name:LYDIA APPIAH DWAMENA, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIAH-DWAMENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-922-3331
Mailing Address - Street 1:102 PALO ALTO ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3795
Mailing Address - Country:US
Mailing Address - Phone:210-922-3331
Mailing Address - Fax:210-922-3339
Practice Address - Street 1:102 PALO ALTO ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3795
Practice Address - Country:US
Practice Address - Phone:210-922-3331
Practice Address - Fax:210-922-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7963207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287645001Medicaid
TX165448503Medicaid
TX00Z554Medicare PIN
I05031Medicare UPIN