Provider Demographics
NPI:1548588056
Name:MABRY, LINDSEY G (DO)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:G
Last Name:MABRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W WENGER RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2722
Mailing Address - Country:US
Mailing Address - Phone:937-771-5100
Mailing Address - Fax:937-832-3014
Practice Address - Street 1:1109 GRANBY RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1568
Practice Address - Country:US
Practice Address - Phone:413-523-0824
Practice Address - Fax:413-523-0930
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-011284207V00000X
MA266570207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105614Medicaid
OH0105614Medicaid
OHH360370Medicare PIN