Provider Demographics
NPI:1750186938
Name:LEXINGTON MEDICAL TATTOOING
Entity type:Organization
Organization Name:LEXINGTON MEDICAL TATTOOING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-550-6224
Mailing Address - Street 1:166 PROSPEROUS PL STE 300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2178
Mailing Address - Country:US
Mailing Address - Phone:859-550-6224
Mailing Address - Fax:
Practice Address - Street 1:166 PROSPEROUS PL STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2178
Practice Address - Country:US
Practice Address - Phone:859-550-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty