Provider Demographics
NPI:1518901081
Name:MORGAN, LYNDON W (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:W
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 NORTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6060
Mailing Address - Country:US
Mailing Address - Phone:207-338-2571
Mailing Address - Fax:207-338-3810
Practice Address - Street 1:158 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6060
Practice Address - Country:US
Practice Address - Phone:207-338-2571
Practice Address - Fax:207-338-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12097207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME118130000Medicaid
MED03570Medicare UPIN
MEMM5147Medicare ID - Type UnspecifiedROCKLAND OFFICE
MEMM0505Medicare ID - Type UnspecifiedBELFAST OFFICE