1295997617 NPI number — MISS LYNN A AMICONE DO

Table of content: MISS LYNN A AMICONE DO (NPI 1295997617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295997617 NPI number — MISS LYNN A AMICONE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMICONE
Provider First Name:
LYNN
Provider Middle Name:
A
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1295997617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 S 2ND ST
Provider Second Line Business Mailing Address:
SUITE 2F
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17104-1612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 4B
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17101-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-231-8472
Provider Business Practice Location Address Fax Number:
717-231-8490
Provider Enumeration Date:
06/26/2008

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: 207V00000X , with the licence number:  OS016125 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: OS016125 , 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: 103041396 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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