Provider Demographics
NPI:1366419442
Name:NORTON, LYDIA W (MD)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:W
Last Name:NORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:WAGUESPACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2499 S CAPITAL OF TEXAS HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7762
Mailing Address - Country:US
Mailing Address - Phone:512-328-7666
Mailing Address - Fax:512-328-3547
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7762
Practice Address - Country:US
Practice Address - Phone:512-328-7666
Practice Address - Fax:512-328-3547
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1486281Medicaid
LA5H324Medicare ID - Type Unspecified
H17464Medicare UPIN