Provider Demographics
NPI:1235557364
Name:DEWBERRY, LINDEL (MD)
Entity Type:Individual
Prefix:
First Name:LINDEL
Middle Name:
Last Name:DEWBERRY
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 1:740 S LIMESTONE STE J201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-218-2522
Mailing Address - Fax:859-323-3918
Practice Address - Street 1:740 S LIMESTONE STE J201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2570
Practice Address - Country:US
Practice Address - Phone:859-218-2522
Practice Address - Fax:859-323-3918
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY582142086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program