Basic Information
Provider Information
NPI: 1366762536
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANONICH
FirstName: LINDSAY
MiddleName: R.
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 425
Address2:  
City: LEDERACH
State: PA
PostalCode: 194500425
CountryCode: US
TelephoneNumber: 8005280006
FaxNumber: 7323496030
Practice Location
Address1: 140 NUTT RD
Address2:  
City: PHOENIXVILLE
State: PA
PostalCode: 194603906
CountryCode: US
TelephoneNumber: 8005280006
FaxNumber: 7323496030
Other Information
ProviderEnumerationDate: 06/10/2010
LastUpdateDate: 09/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA054380PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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