Provider Demographics
NPI:1063488351
Name:MCCRILLIS, LYNNE (DO)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:MCCRILLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 SHENANGO ST
Practice Address - Street 2:SUITE 12
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2060
Practice Address - Country:US
Practice Address - Phone:724-589-0290
Practice Address - Fax:724-589-0293
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006640L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012219640002Medicaid
PA0012219640002Medicaid
E71412Medicare UPIN