Individual provider Active NPI

Lydia McDermott, PA-C

  • Surgical Physician Assistant
  • Cherry Hill, NJ
National Provider Identifier
1053753301
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
25MP00508300 Issued in NJ
Practice address
1 Brace Rd Ste H-1
Cherry Hill, NJ 08034-2600
Phone
(856) 547-0389
Fax
(856) 428-4053
NPI assigned
Jul 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00508300 NJ
Surgical Physician Assistant 363AS0400X 25MP00508300 NJ Primary

Addresses

Primary practice location

1 Brace Rd Ste H-1
Cherry Hill, NJ 08034-2600

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

111 S 11th St
Thomas Jefferson University Hospital
Philadelphia, PA 19107-4824
Phone (215) 955-7070

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lmcdermott207223@directvirtua.org
Direct Messaging Address lmcdermott207223@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180131000221 PA Practitioner - Physician Assistant 2961762513 Reassigns benefits to 1 organization
I20211118000123 NJ Practitioner - Physician Assistant 2961762513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

1600 Haddon Ave
Camden, NJ 08103-3101

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

  • Virtua Our Lady of Lourdes Hospital Hospital, Camden, NJ, CCN 310029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA Physician Assistant CurrentSince Dec 1, 2021 Accepting new patients
Jefferson University Physicians CurrentSince Dec 12, 2017 Accepting new patients
Virtua Medical Group, PA CurrentSince Dec 1, 2021 Accepting new patients
Virtua Medical Group, PA Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1 Brace Rd
Bldg 1-H
Cherry Hill, NJ 08034
Phone (856) 547-0389

301 Lippincott Dr
Ste 120
Marlton, NJ 08053
Phone (856) 355-0333

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

1100 Walnut St
Ste 500
Philadelphia, PA 19107
Phone (215) 955-6750

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1053753301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRACE RD STE H-1",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080342600",
            "telephone_number": "856-547-0389",
            "fax_number": "856-428-4053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 S 11th St",
            "address_2": "Thomas Jefferson University Hospital",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074824",
            "country_code": "US",
            "telephone_number": "215-955-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDERMOTT",
        "first_name": "LYDIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-26",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00508300",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00508300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmcdermott207223@directvirtua.org",
            "affiliation": "N",
            "address_1": "1 Brace Rd Ste H-1",
            "city": "Cherry Hill",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080342600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmcdermott207223@directvirtua.org",
            "affiliation": "N",
            "address_1": "1600 Haddon Ave",
            "city": "Camden",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "081033101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.