Provider Demographics
NPI:1518927136
Name:SORENSEN, LYNDA M (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:SORENSEN
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 1:12 WHITING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6124
Mailing Address - Country:US
Mailing Address - Phone:716-694-8851
Mailing Address - Fax:716-694-5941
Practice Address - Street 1:12 WHITING ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6124
Practice Address - Country:US
Practice Address - Phone:716-694-8851
Practice Address - Fax:716-694-5941
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173722207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0307845OtherINDEPENDENT HEALTH
000510939001OtherBCBS WNY
070017414OtherRAILROAD MEDICARE
00010170501OtherUNIVERA
0307845OtherINDEPENDENT HEALTH
00010170501OtherUNIVERA