Provider Demographics
NPI:1174670038
Name:FENLASON, LINDY (MD)
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:FENLASON
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 1:1630 EUCLID ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5675
Mailing Address - Country:US
Mailing Address - Phone:202-476-5580
Mailing Address - Fax:
Practice Address - Street 1:1630 EUCLID ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5675
Practice Address - Country:US
Practice Address - Phone:202-476-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442767208000000X
TNMD43493208000000X
DCMD456456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD456456OtherDC MEDICAL LICENSE