Provider Demographics
NPI:1386600765
Name:STIDHAM, LYNDA MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:MARGARET
Last Name:STIDHAM
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 1:32 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14069-9632
Mailing Address - Country:US
Mailing Address - Phone:716-592-4842
Mailing Address - Fax:
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1244
Practice Address - Country:US
Practice Address - Phone:716-592-2832
Practice Address - Fax:716-592-4452
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171500OtherNYS LICENSE
NY01051481Medicaid
NY01051481Medicaid