Provider Demographics
NPI:1972677516
Name:LINDO, WALFORD B (MD)
Entity Type:Individual
Prefix:DR
First Name:WALFORD
Middle Name:B
Last Name:LINDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 GLENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210
Mailing Address - Country:US
Mailing Address - Phone:718-859-0008
Mailing Address - Fax:718-434-4470
Practice Address - Street 1:3304 GLENWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210
Practice Address - Country:US
Practice Address - Phone:718-859-0008
Practice Address - Fax:718-434-4470
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00637816Medicaid
NY00637816Medicaid
NY00637816Medicaid