Provider Demographics
NPI:1508978784
Name:FUNDENBERGER, LINDA A (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:FUNDENBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 E 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218
Mailing Address - Country:US
Mailing Address - Phone:317-547-5525
Mailing Address - Fax:317-543-0948
Practice Address - Street 1:2815 E 38TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218
Practice Address - Country:US
Practice Address - Phone:317-547-5525
Practice Address - Fax:317-543-0948
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036129A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176610AMedicaid
IN100176610AMedicaid
IN0529350001Medicare NSC
E90716Medicare UPIN