Provider Demographics
NPI:1619253663
Name:WALFORD B LINDO MD PC
Entity Type:Organization
Organization Name:WALFORD B LINDO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALFORD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-859-0008
Mailing Address - Street 1:3304 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2724
Mailing Address - Country:US
Mailing Address - Phone:718-859-0008
Mailing Address - Fax:718-434-4470
Practice Address - Street 1:3304 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2724
Practice Address - Country:US
Practice Address - Phone:718-859-0008
Practice Address - Fax:718-434-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2018-03-20
Deactivation Date:2016-03-11
Deactivation Code:
Reactivation Date:2018-03-20
Provider Licenses
StateLicense IDTaxonomies
NY142321261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1972677516OtherNPI- INDIVIDUAL
NY00637816Medicaid
NYC09688Medicare UPIN