1609905264 NPI number — LYNN R. WILLIAMS, M.D. P.C.

Table of content: (NPI 1609905264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609905264 NPI number — LYNN R. WILLIAMS, M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNN R. WILLIAMS, M.D. P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DERMATOLOGY ASSOCIATES OF LAWRENCE COUNTY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609905264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 WILMINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16105-1131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-656-8940
Provider Business Mailing Address Fax Number:
724-656-8942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 WILMINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-656-8940
Provider Business Practice Location Address Fax Number:
724-656-8942
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-656-8940

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD042981L , 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: 001332161 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3046212 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7993414 . This is a "AETNA INSURANCE CO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CK4548 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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