Provider Demographics
NPI:1194016790
Name:BARTHOLOME, LINDSAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:
Last Name:BARTHOLOME
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 1:22650 N 54TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-7163
Mailing Address - Country:US
Mailing Address - Phone:651-373-7465
Mailing Address - Fax:
Practice Address - Street 1:1450 S DOBSON RD STE A200
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4742
Practice Address - Country:US
Practice Address - Phone:480-629-5167
Practice Address - Fax:480-912-1068
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54653208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ303765Medicaid