Provider Demographics
NPI:1487835914
Name:MARK LINDEMANN DO PA
Entity Type:Organization
Organization Name:MARK LINDEMANN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-763-8300
Mailing Address - Street 1:PO BOX 163524
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-3524
Mailing Address - Country:US
Mailing Address - Phone:817-763-8300
Mailing Address - Fax:817-377-9486
Practice Address - Street 1:4545 BELLAIRE DR S STE 9
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1811
Practice Address - Country:US
Practice Address - Phone:817-763-8300
Practice Address - Fax:817-377-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612361Medicare PIN