Provider Demographics
NPI:1114918166
Name:FANN, LYNDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:M
Last Name:FANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LINDEN PONDS WAY
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3791
Mailing Address - Country:US
Mailing Address - Phone:781-534-7100
Mailing Address - Fax:
Practice Address - Street 1:300 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3791
Practice Address - Country:US
Practice Address - Phone:781-534-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0021092OtherNEIGHBORHOOD HLTH PLAN
MA042297845OtherGIC UNICARE
MA154023OtherTUFTS
MA68861OtherHVD PILGRIM HEALTH CARE
MA042297845OtherHCVM
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA33931OtherFALLON
MAJ17806OtherBCBS
MA154023OtherSECURE HORIZONS
MA5452575OtherAETNA
MA042297845OtherDOC FIRST
MAB10358401OtherCIGNA
MA042297845OtherUNITED HEALTH CARE
MA042297845OtherGREAT WEST HEALTH CARE
MA3171434Medicaid
MA042297845OtherTRICARE