Provider Demographics
NPI:1497956676
Name:THATTASSERY, LINDSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:THATTASSERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:LUKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-494-1355
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:750 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2515
Practice Address - Country:US
Practice Address - Phone:410-526-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070086208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
195473ZR0ZMedicare PIN
MD157676Medicare PIN