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General NPI Number Information
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NPI Number | 1578510871
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Entity Type | Organization
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Legal Business Name | KENNETH R. LINDYBERG MD, PC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6701 N CHARLES ST SUITE 4430
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City | BALTIMORE
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State | MD
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Zip | 21204-6808
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Country | US
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Telephone | 443-849-6212
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Fax | 443-849-6217
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Provider Business Mailing Address
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Address Line | 2916 GREENE RD
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City | BALDWIN
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State | MD
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Zip | 21013-9102
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Country | US
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Telephone | 410-557-0451
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Fax | 410-557-0451
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH RAYMOND LINDYBERG
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Credential | M.D.
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Telephone | 410-557-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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