Provider Demographics
NPI:1831351063
Name:AGOLIA, LINDSAY ROSE (MD)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:ROSE
Last Name:AGOLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1000
Mailing Address - Country:US
Mailing Address - Phone:510-428-4900
Mailing Address - Fax:510-428-4904
Practice Address - Street 1:1345 GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1000
Practice Address - Country:US
Practice Address - Phone:510-428-4900
Practice Address - Fax:510-428-4904
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA11393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN