Provider Demographics
NPI:1225046451
Name:SMOLIK, LYNN M (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SMOLIK
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:CAROGA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12032-0063
Mailing Address - Country:US
Mailing Address - Phone:650-322-2055
Mailing Address - Fax:650-322-0639
Practice Address - Street 1:1010 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3919
Practice Address - Country:US
Practice Address - Phone:650-322-2055
Practice Address - Fax:650-322-0639
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5283402086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18264Medicare UPIN
CA00G528340Medicare ID - Type Unspecified