Healthcare Provider Details

I. General information

NPI: 1366588790
Provider Name (Legal Business Name): MARK EVAN LINDSAY M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST BRADY 5TH FLOOR
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

8806 LOWELL PL
BETHESDA MD
20817-3222
US

V. Phone/Fax

Practice location:
  • Phone: 410-434-2734
  • Fax:
Mailing address:
  • Phone: 410-434-2734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number18473
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberD67923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: