Provider Demographics
NPI:1477096782
Name:STODDARD LYNDSEY, MARIE ALEXIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ALEXIA
Last Name:STODDARD LYNDSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ALEXIA
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:8401 PINE AVE STE 120
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-9658
Practice Address - Country:US
Practice Address - Phone:909-789-0937
Practice Address - Fax:909-654-3039
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171336207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology