Provider Demographics
NPI:1639139306
Name:LINDENBAUM, MARK (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LINDENBAUM
Suffix:
Gender:M
Credentials:MD, PHD
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 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-715-4186
Mailing Address - Fax:360-715-4143
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-715-4186
Practice Address - Fax:360-715-4143
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025775207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639139306Medicaid
WA8486086Medicaid
WA6564LIOtherREGENCE
WA4586038OtherAETNA
WAG8851359Medicare PIN
A52832Medicare UPIN