Basic Information
Provider Information
NPI: 1174968911
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARCUS
FirstName: LYDIA
MiddleName: ROBINSON
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 625 19TH ST S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352331900
CountryCode: US
TelephoneNumber: 2056386980
FaxNumber:  
Practice Location
Address1: 1600 7TH AVE S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352331711
CountryCode: US
TelephoneNumber: 2059967850
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/07/2013
LastUpdateDate: 12/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0402X33537ALY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology

No ID Information.


Home