Provider Demographics
NPI:1083784615
Name:LINDENMUTH, NORMAN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:WILLIAM
Last Name:LINDENMUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1070
Mailing Address - Country:US
Mailing Address - Phone:315-536-3308
Mailing Address - Fax:315-536-0430
Practice Address - Street 1:418 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1070
Practice Address - Country:US
Practice Address - Phone:315-536-3308
Practice Address - Fax:315-536-0430
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00447058Medicaid
B76774Medicare UPIN
NY00447058Medicaid