Healthcare Provider Details

I. General information

NPI: 1881953404
Provider Name (Legal Business Name): LINDSAY RAE BARTRAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 HUFFMAN MILL RD STE 101
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-6161
  • Fax: 336-230-2150
Mailing address:
  • Phone: 614-722-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number2023-00136
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number34.011793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: