Provider Demographics
NPI:1699705061
Name:FERRARA, LINDSAY BAUMANN (PA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BAUMANN
Last Name:FERRARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:A
Other - Last Name:BAUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:POBOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-793-9226
Mailing Address - Fax:
Practice Address - Street 1:3424 SHELBY RAY CT
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5838
Practice Address - Country:US
Practice Address - Phone:843-402-6834
Practice Address - Fax:843-573-9963
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1114363A00000X
NY016508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ70073Medicare UPIN
SCAA13635163Medicare PIN