1497798797 NPI number — LYNN M POTTS MD

Table of content: LYNN M POTTS MD (NPI 1497798797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497798797 NPI number — LYNN M POTTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTTS
Provider First Name:
LYNN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUCEVIC
Provider Other First Name:
LYNN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497798797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 PENN CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15235-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-825-0881
Provider Business Mailing Address Fax Number:
412-824-1261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1907 LEBANON CHURCH RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MIFFLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15122-2452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-650-9700
Provider Business Practice Location Address Fax Number:
412-650-9604
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD069303L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7582128 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080156247 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208668 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P001908 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001781084 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 334862 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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