Healthcare Provider Details

I. General information

NPI: 1245344431
Provider Name (Legal Business Name): LINCOLN PAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

140 S BEDFORD RD
CHAPPAQUA NY
10514-3400
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3951
  • Fax:
Mailing address:
  • Phone: 914-238-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0067105
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number183421
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.074278
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: