Healthcare Provider Details

I. General information

NPI: 1568082469
Provider Name (Legal Business Name): JOSHUA LEE VANDEBURGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NICHOLASVILLE RD STE 601A
LEXINGTON KY
40503-1404
US

IV. Provider business mailing address

1720 NICHOLASVILLE RD STE 601A
LEXINGTON KY
40503-1404
US

V. Phone/Fax

Practice location:
  • Phone: 859-639-0905
  • Fax: 859-639-0906
Mailing address:
  • Phone: 859-639-0905
  • Fax: 859-639-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberTP469
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: