Provider Demographics
NPI:1174581896
Name:LYDEN, BRIAN R (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:LYDEN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:7650 E PARHAM RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4373
Mailing Address - Country:US
Mailing Address - Phone:804-270-5163
Mailing Address - Fax:804-270-0079
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-270-5163
Practice Address - Fax:804-270-0079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006097B70Medicare ID - Type Unspecified
VAQ30990Medicare UPIN