Provider Demographics
NPI:1275521114
Name:BICKLEY, LYNN KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:KATHLEEN
Last Name:BICKLEY
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 2350
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8945
Mailing Address - Country:US
Mailing Address - Phone:410-822-9890
Mailing Address - Fax:410-763-9536
Practice Address - Street 1:6412 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-2386
Practice Address - Country:US
Practice Address - Phone:410-810-7090
Practice Address - Fax:410-810-7091
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047069207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD475648OtherMAMSI PLANS
MDK859TAOtherBLUE SHIELD
MDP000031306OtherMC RAILROAD
MDW0170002OtherBLUE SHIELD
MD538MF616Medicare ID - Type Unspecified
MDP000031306OtherMC RAILROAD