Healthcare Provider Details

I. General information

NPI: 1235763152
Provider Name (Legal Business Name): MICHAEL R LINDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 LEE ST
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5115
  • Fax: 434-244-4504
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101289705
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: