Provider Demographics
NPI:1033404512
Name:PELBATH, LYNDSEY MAUREEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LYNDSEY
Middle Name:MAUREEN
Last Name:PELBATH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:MAUREEN
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:354 FOLLY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2594
Mailing Address - Country:US
Mailing Address - Phone:843-225-2374
Mailing Address - Fax:434-591-9238
Practice Address - Street 1:354 FOLLY RD STE 5
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2594
Practice Address - Country:US
Practice Address - Phone:843-225-2374
Practice Address - Fax:843-459-1923
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant