MEDICARE: LINDSAY AGOSTINELLI MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	25MA12834800	NJ
2	2084N0400X	Neurology Physician	MD490182	PA

General Provider Information

NPI Number	:	1861079675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY AGOSTINELLI MD, PHD

Provider Business Mailing Address
First Line	:	3400 SPRUCE STREET
Second Line	:	3 W GATES
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-662-3606
Fax Number	:	215-829-6606

Provider Business Practice Location Address
First Line	:	330 SOUTH NINTH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6103
Country	:	US
Telephone Number	:	215-662-3606
Fax Number	:	215-829-6606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	04/10/2026

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