Provider Demographics
NPI:1073549341
Name:LINDGREN, ELAINE KAREN MOBBS (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:KAREN MOBBS
Last Name:LINDGREN
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 1:70 ONEIL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3510
Mailing Address - Country:US
Mailing Address - Phone:845-340-9506
Mailing Address - Fax:845-340-9509
Practice Address - Street 1:70 ONEIL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3510
Practice Address - Country:US
Practice Address - Phone:845-340-9506
Practice Address - Fax:845-340-9509
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235039207Q00000X
NY235039-1207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02816342Medicaid
NY02640980Medicaid
NY1932304532OtherGROUP NPI
NYI57938Medicare UPIN
NY02816342Medicaid
NYWEU861Medicare PIN
NY4333PEU861Medicare PIN