Provider Demographics
NPI:1548295827
Name:LINDBERG, NANCY H (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:H
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ELM ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3700
Mailing Address - Country:US
Mailing Address - Phone:860-741-3069
Mailing Address - Fax:860-745-3864
Practice Address - Street 1:113 ELM ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3700
Practice Address - Country:US
Practice Address - Phone:860-741-3069
Practice Address - Fax:860-745-3864
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080135197OtherRAILROAD MEDICARE
CT1548295827Medicaid
CT080001296Medicare PIN
CT080135197OtherRAILROAD MEDICARE