Provider Demographics
NPI:1770760100
Name:ROBERT A. LINDBERG, MD, LLC
Entity type:Organization
Organization Name:ROBERT A. LINDBERG, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-656-1012
Mailing Address - Street 1:1500 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5935
Mailing Address - Country:US
Mailing Address - Phone:203-656-1012
Mailing Address - Fax:203-656-1005
Practice Address - Street 1:1500 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5935
Practice Address - Country:US
Practice Address - Phone:203-656-1012
Practice Address - Fax:203-656-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025927261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84080Medicare UPIN