Provider Demographics
NPI:1417916677
Name:LINDERMAN PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:LINDERMAN PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-847-0757
Mailing Address - Street 1:PO BOX 2563
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-2563
Mailing Address - Country:US
Mailing Address - Phone:704-847-0757
Mailing Address - Fax:704-844-2068
Practice Address - Street 1:167L S TRADE ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5771
Practice Address - Country:US
Practice Address - Phone:704-847-0757
Practice Address - Fax:704-844-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890154CMedicaid