Lida Eatedali, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301084937 Issued in MI

Practice address

1111 East End Blvd
Vamc.
Wilkes Barre, PA 18711

Phone

(570) 824-3521

NPI assigned

Jul 25, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003838103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 INDIAN CREEK DR",
            "address_2": "WILKES WOOD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027826",
            "telephone_number": "570-820-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 EAST END BLVD",
            "address_2": "VAMC.",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "18711",
            "telephone_number": "570-824-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATEDALI",
        "first_name": "LIDA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301084937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "4301084937",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Dworak, OTR/L, ATP
• Jacquelyn A Dwyer, PHARM D
• Calvin J. Dysinger, M.D.
• Joseph Dzurishin
• Maria A Eastman, CRNP MSN NP-C
• Alaleh Ebrahimi, DO
• Madelin Eck, PT
• Gerald Eckenrode, R.R.T.
• John Edmund Edwards, RPH, PHARMD
• Monica P Edwards, MD

• Internal Medicine Physician in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.