Provider Demographics
NPI:1174569289
Name:TINDALL, JANICE C (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:TINDALL
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 1:101 ABBEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4603
Mailing Address - Country:US
Mailing Address - Phone:717-291-5991
Mailing Address - Fax:717-291-5806
Practice Address - Street 1:101 ABBEYVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4603
Practice Address - Country:US
Practice Address - Phone:717-291-5991
Practice Address - Fax:717-291-5806
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025187E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000905660Medicaid
TI418004Medicare ID - Type Unspecified
PA000905660Medicaid