Basic Information
Provider Information
NPI: 1609495035
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEST
FirstName: LINDSAY
MiddleName: ALEXANDRA
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: ONE MEDICAL CENTER BLVD.
Address2: ACP SUITE 332
City: UPLAND
State: PA
PostalCode: 19013
CountryCode: US
TelephoneNumber: 6104477612
FaxNumber:  
Practice Location
Address1: ONE MEDICAL CENTER BLVD
Address2: ACP SUITE 332
City: UPLAND
State: PA
PostalCode: 19013
CountryCode: US
TelephoneNumber: 6104477612
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/15/2020
LastUpdateDate: 04/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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