Provider Demographics
NPI:1922554872
Name:KRISTEN LINDGREN MD PHD LLC
Entity Type:Organization
Organization Name:KRISTEN LINDGREN MD PHD LLC
Other - Org Name:DR KRISTEN LINDGREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHILD NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:617-762-1540
Mailing Address - Street 1:193 OAK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1453
Mailing Address - Country:US
Mailing Address - Phone:617-762-1540
Mailing Address - Fax:617-412-3064
Practice Address - Street 1:193 OAK ST STE 1
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1453
Practice Address - Country:US
Practice Address - Phone:617-762-1540
Practice Address - Fax:617-412-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2671012084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110110774AMedicaid