Provider Demographics
NPI:1154364966
Name:ROBERT N. LINDHOLM, MD, PC
Entity type:Organization
Organization Name:ROBERT N. LINDHOLM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:LINDHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-892-0801
Mailing Address - Street 1:1098 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3307
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-892-0801
Mailing Address - Fax:610-892-9552
Practice Address - Street 1:1098 W. BALTIMORE PIKE
Practice Address - Street 2:SUITE 3307
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-892-0801
Practice Address - Fax:610-892-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035817E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124166Medicare PIN
PAB36788Medicare UPIN