Healthcare Provider Details

I. General information

NPI: 1396201752
Provider Name (Legal Business Name): BLUEBERRY MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST FL 8
BALTIMORE MD
21202-3180
US

IV. Provider business mailing address

2672 BAYSHORE PKWY STE 608
MOUNTAIN VIEW CA
94043-1017
US

V. Phone/Fax

Practice location:
  • Phone: 754-702-7256
  • Fax: 844-204-0781
Mailing address:
  • Phone: 407-497-9203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNDSEY GARBI
Title or Position: OWNER
Credential: MD
Phone: 407-497-9207