Provider Demographics
NPI:1427312321
Name:DILLON, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COUNTY HIGHWAY 33W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-4953
Mailing Address - Country:US
Mailing Address - Phone:607-547-6474
Mailing Address - Fax:607-547-6402
Practice Address - Street 1:140 COUNTY HIGHWAY 33W
Practice Address - Street 2:SUITE 3
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-4953
Practice Address - Country:US
Practice Address - Phone:607-547-6474
Practice Address - Fax:607-547-6402
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator