Provider Demographics
NPI:1275503245
Name:LIND, MARITA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITA
Middle Name:E
Last Name:LIND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARITA
Other - Middle Name:E
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-5158
Practice Address - Fax:717-531-0370
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07321700208000000X
NJ25MA073217002080C0008X
PAMD055509L2080C0008X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7216009Medicaid
NJG24322Medicare UPIN