Provider Demographics
NPI:1164441010
Name:JOUBERT, INA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:INA
Middle Name:LYNN
Last Name:JOUBERT
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 1:209 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627-1092
Mailing Address - Country:US
Mailing Address - Phone:724-694-0516
Mailing Address - Fax:
Practice Address - Street 1:STATE ROUTE 1014
Practice Address - Street 2:TORRANCE STATE HOSPITAL
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779
Practice Address - Country:US
Practice Address - Phone:724-459-4514
Practice Address - Fax:724-459-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041388L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF17129Medicare UPIN
PA710979Medicare ID - Type Unspecified