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General NPI Number Information
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NPI Number | 1588031157
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Entity Type | Organization
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Legal Business Name | LINCOLN MEDICAL PRACTICE INC
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Dates
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Enumeration Date | 08/29/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 89 LINCOLN BLVD
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City | LINCOLN
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State | CA
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Zip | 95648-6315
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Country | US
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Telephone | 916-434-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 89 LINCOLN BLVD
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City | LINCOLN
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State | CA
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Zip | 95648-6315
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Country | US
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Telephone | 916-434-8800
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSCIAN
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Name | SARALA GHANAPURAM
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Credential | MD
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Telephone | 845-542-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A137432
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License Number State | CA
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