Wallace, Lydia
Wallace, Lydia is an sole proprietor health care provider with primary practice located at 235 N Pearl St , Brockton MA 02301-1794. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Wallace, Lydia can be contacted via phone (617) 414-5405.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | MD2019-0840 | New Mexico |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 1024211 | Massachusetts |
Profile Details
| NPI number | 1417344581 |
|---|---|
| LBN Legal business name | Wallace, Lydia |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 16th, 2015 |
| Last updated | Aug 2nd, 2025 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417344581 | NPPES |
| New Mexico | Other | MD2019-08 | LICENSE |
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