| Lydia Potoma Llc | |
|
18051 Jefferson Park Rd Ste 102 Middleburg Heights OH 44130-3460 | |
| (216) 403-1291 | |
| Not Available |
| Full Name | Lydia Potoma Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 18051 Jefferson Park Rd Ste 102, Middleburg Heights, Ohio |
| Authorized Official Name and Position | Lydia Lee Potoma (OWNER) |
| Authorized Official Contact | 2164031291 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lydia Potoma Llc 18051 Jefferson Park Rd Ste 102 Middleburg Heights OH 44130-3460 Ph: (216) 403-1291 | Lydia Potoma Llc 18051 Jefferson Park Rd Ste 102 Middleburg Heights OH 44130-3460 Ph: (216) 403-1291 |
| NPI Number | 1659177699 |
|---|---|
| Provider Enumeration Date | 02/20/2025 |
| Last Update Date | 02/20/2025 |
| Certification Date | 02/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659177699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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