Provider Demographics
NPI:1063116028
Name:LAMBERTY, MATILDA
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:LAMBERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N THOMAS RD APT 11C
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1723
Mailing Address - Country:US
Mailing Address - Phone:440-864-7315
Mailing Address - Fax:
Practice Address - Street 1:72 N THOMAS RD APT 11C
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1723
Practice Address - Country:US
Practice Address - Phone:440-864-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty