Provider Demographics
NPI:1831197128
Name:LINDBERG, NICHOLAS O (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:O
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 LAWN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1571
Mailing Address - Country:US
Mailing Address - Phone:215-257-0414
Mailing Address - Fax:215-257-1740
Practice Address - Street 1:670 LAWN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1571
Practice Address - Country:US
Practice Address - Phone:215-257-0414
Practice Address - Fax:215-257-1740
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041567E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100769OtherOTHER BC
PA112878OtherAETNA
PA1030912OtherOTHER HMO (MERCY)
PA0012706000001Medicaid
PA0444036000OtherINDEPENDENCE BLUE CROSS
PA615735FC3Medicare ID - Type UnspecifiedMEDICARE
PA100769OtherOTHER BC