Provider Demographics
NPI:1770247728
Name:MARIE STODDARD LYNDSEY MD PC
Entity type:Organization
Organization Name:MARIE STODDARD LYNDSEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LYNDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-949-7500
Mailing Address - Street 1:954 W FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3782
Mailing Address - Country:US
Mailing Address - Phone:909-949-7500
Mailing Address - Fax:909-946-1133
Practice Address - Street 1:954 W FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3782
Practice Address - Country:US
Practice Address - Phone:909-949-7500
Practice Address - Fax:909-946-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty