Provider Demographics
NPI:1174589972
Name:GHIDONI, LORRAINE A (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:A
Last Name:GHIDONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVE # 3
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2017
Mailing Address - Country:US
Mailing Address - Phone:214-820-4012
Mailing Address - Fax:214-820-7757
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:#3 HOBLITZELLE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-4012
Practice Address - Fax:214-820-7757
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8849208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics