Healthcare Provider Details
I. General information
NPI: 1942746144
Provider Name (Legal Business Name): LINDSAY WELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 01/11/2017
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2700 QUARRY LAKE DR
BALTIMORE MD
21209-3742
US
IV. Provider business mailing address
6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US
V. Phone/Fax
- Phone: 410-705-7972
- Fax:
- Phone: 410-933-6423
- Fax: 410-500-4266
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | C07838 |
| License Number State | MD |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363AS0400X |
| Taxonomy | Surgical Physician Assistant |
| License Number | 54128 |
| License Number State | CA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363AM0700X |
| Taxonomy | Medical Physician Assistant |
| License Number | 54128 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: