Provider Demographics
NPI:1578510871
Name:KENNETH R. LINDYBERG MD, PC
Entity Type:Organization
Organization Name:KENNETH R. LINDYBERG MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LINDYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-557-0451
Mailing Address - Street 1:2916 GREENE RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9102
Mailing Address - Country:US
Mailing Address - Phone:410-557-0451
Mailing Address - Fax:410-557-0451
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE 4430
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-6212
Practice Address - Fax:443-849-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty