Provider Demographics
NPI:1366003170
Name:LINCOLN, VADIM VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VADIM
Middle Name:VICTOR
Last Name:LINCOLN
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 1:65 SADDLEBOW RD
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1137
Mailing Address - Country:US
Mailing Address - Phone:818-703-0121
Mailing Address - Fax:
Practice Address - Street 1:2320 BATH ST STE 205
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5313
Practice Address - Country:US
Practice Address - Phone:805-569-1164
Practice Address - Fax:805-569-1094
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182477207ND0101X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program