Provider Demographics
NPI:1558350215
Name:BASCELLI, LYNDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:BASCELLI
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 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:563-550-3408
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1605 E EVESHAM RD STE 200B
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1437
Practice Address - Country:US
Practice Address - Phone:856-322-3110
Practice Address - Fax:856-322-3111
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07428000207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8920907Medicaid
NJ8920907Medicaid
062879YBAWMedicare PIN
NJH39943Medicare UPIN