Provider Demographics
NPI:1659307270
Name:LINCOLN INTERNAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:LINCOLN INTERNAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-736-9188
Mailing Address - Street 1:P.O. BOX 70
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093
Mailing Address - Country:US
Mailing Address - Phone:704-736-9188
Mailing Address - Fax:704-736-9667
Practice Address - Street 1:607 S. GENERALS BLVD.
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-736-9188
Practice Address - Fax:704-736-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114730207R00000X, 207RG0300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017NTOtherBCBS NC
7479411OtherAETNA
CK8825OtherRAILROAD MEDICARE
NC5902610Medicaid
2103097OtherMAMSI/ALLIANCE
612434200OtherBLACK LUNG PROGRAM
7479411OtherAETNA
CK8825Medicare PIN