Healthcare Provider Details

I. General information

NPI: 1366003170
Provider Name (Legal Business Name): VADIM VICTOR LINCOLN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2019
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 205
SANTA BARBARA CA
93105-5313
US

IV. Provider business mailing address

65 SADDLEBOW RD
BELL CANYON CA
91307-1137
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-1164
  • Fax: 805-569-1094
Mailing address:
  • Phone: 818-703-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number182477
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number182477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: