Provider Demographics
NPI:1689054371
Name:WESSELS, LYNDSEY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDSEY
Middle Name:ELIZABETH
Last Name:WESSELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNDSEY
Other - Middle Name:ELIZABETH
Other - Last Name:KISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1215 LEE ST BOX 800719
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-2150
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-5000
Practice Address - Country:US
Practice Address - Phone:434-924-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 390200000X
NE29380208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171000000XOther Service ProvidersMilitary Health Care Provider
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN