Provider Demographics
NPI:1770569865
Name:THOMAS-MABINE, LYNDA T (MD)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:T
Last Name:THOMAS-MABINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:T
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8815 GERMANTOWN AVE
Mailing Address - Street 2:STE. 40
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2722
Mailing Address - Country:US
Mailing Address - Phone:215-248-3100
Mailing Address - Fax:215-248-3971
Practice Address - Street 1:8815 GERMANTOWN AVE
Practice Address - Street 2:STE. 40
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-248-3100
Practice Address - Fax:215-248-3971
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028143E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE64182Medicare UPIN