Provider Demographics
NPI:1144204363
Name:MCCOLGAN, LYNN M (PA)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:MCCOLGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:AVEZZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:592 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1461
Mailing Address - Country:US
Mailing Address - Phone:413-547-0012
Mailing Address - Fax:413-547-0034
Practice Address - Street 1:592 CENTER ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1461
Practice Address - Country:US
Practice Address - Phone:413-547-0012
Practice Address - Fax:413-547-0034
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1889363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34590Medicare UPIN
AP2327Medicare ID - Type Unspecified