Provider Demographics
NPI:1073563698
Name:DUNCAN, LYN MCDIVITT (MD)
Entity Type:Individual
Prefix:DR
First Name:LYN
Middle Name:MCDIVITT
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYN
Other - Middle Name:STUART MCDIVITT
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:WRN 825
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-5209
Mailing Address - Fax:617-643-1624
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WRN 825
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-5209
Practice Address - Fax:617-643-1624
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73791207ND0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11623OtherBCBS MA
MA3083837Medicaid
MA084165OtherTUFTS HEALTH PLAN
E99173Medicare UPIN
MA3083837Medicaid