Provider Demographics
NPI:1316051089
Name:MASUD, LYDIA (MD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MASUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SW 128TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5952
Mailing Address - Country:US
Mailing Address - Phone:305-234-1700
Mailing Address - Fax:305-234-9966
Practice Address - Street 1:8701 SW 128TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5952
Practice Address - Country:US
Practice Address - Phone:305-234-1700
Practice Address - Fax:305-234-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044012208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96700OtherBCBS FL
FL96700OtherBCBS FL