Healthcare Provider Details

I. General information

NPI: 1548588056
Provider Name (Legal Business Name): LINDSEY G MABRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GRANBY RD
CHICOPEE MA
01020-1568
US

IV. Provider business mailing address

20 W WENGER RD
ENGLEWOOD OH
45322-2722
US

V. Phone/Fax

Practice location:
  • Phone: 413-523-0824
  • Fax: 413-523-0930
Mailing address:
  • Phone: 937-771-5100
  • Fax: 937-832-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34-011284
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number266570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: