Provider Demographics
NPI:1306077078
Name:NORTHAM, LINDSAY CAROLYN (MD)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:CAROLYN
Last Name:NORTHAM
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:717 N 190TH PLZ
Practice Address - Street 2:STE. 3200
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3913
Practice Address - Country:US
Practice Address - Phone:402-815-1960
Practice Address - Fax:402-815-1961
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026293200Medicaid
IA1306077078Medicaid
IA1306077078Medicaid