Provider Demographics
NPI:1538481601
Name:GONZALEZ, LINDSAY S (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:S
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2348
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-2348
Mailing Address - Country:US
Mailing Address - Phone:240-629-3912
Mailing Address - Fax:
Practice Address - Street 1:1050 KEY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4053
Practice Address - Country:US
Practice Address - Phone:240-629-3944
Practice Address - Fax:240-629-3945
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004043363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical