Provider Demographics
NPI:1821078437
Name:LINDGREN, KEITH M (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:LINDGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 SHADY GROVE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3235
Mailing Address - Country:US
Mailing Address - Phone:301-990-0040
Mailing Address - Fax:301-990-0043
Practice Address - Street 1:7901 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-891-7000
Practice Address - Fax:301-891-7009
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0007966207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1912021619OtherGROUP NPI
MD212321500Medicaid
MD41270206OtherBCBS-MD
MD1821078437OtherINDIVIDUAL NPI
MD41270206OtherAETNA
DC47870001OtherBCBS-DC
MD41270206OtherBCBS-MD
MD41270206OtherAETNA
DC1821078437Medicare PIN
DC409823Medicare PIN
DC081794C23Medicare PIN