Provider Demographics
NPI:1295937605
Name:LINDBLOM, TERRY MANUS (PA-C)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MANUS
Last Name:LINDBLOM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DEER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-4377
Mailing Address - Country:US
Mailing Address - Phone:508-761-4295
Mailing Address - Fax:
Practice Address - Street 1:1600 CROWN COLONY DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0913
Practice Address - Country:US
Practice Address - Phone:617-509-4873
Practice Address - Fax:617-509-0206
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical