Lida Aghdam, MD
Individual provider Active NPI Internal Medicine Physician · The Colony, TX
NPI 1376572115 · NPPES record last updated Aug 4, 2023
Key facts
- NPI
- 1376572115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- L4208 (TX)
- Practice address
- 4819 State Highway 121 Ste 14
The Colony, TX 75056-2908 - Phone
- (817) 488-7878
- Fax
- (817) 488-7877
- NPI assigned
- Jul 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians and Allied Health Professionals Group, PA | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | L4208 | TX | Yes |
Addresses
Primary practice location
4819 State Highway 121 Ste 14
The Colony, TX 75056-2908
Mailing address
4819 State Highway 121 Ste 14
The Colony, TX 75056-2908
Phone (817) 488-7878
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8BM85 | Other | TX | BCBS OF TEXAS |
Other providers in The Colony, TX
- Lawson Achala
- Achilles Health Care LLC
- Calleigh Alexis Adams
- Adroit Healthcare Services Inc
- Advanced Durable Medical Equipment Supply Inc
- Stanley Akimbom
- Shavonne Akrawi
- Albertsons LLC
- Lydia Ann Albury
- Kristen Ann Aliano Messina
All providers in The Colony, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.