Provider Demographics
NPI:1306393251
Name:MOFENSON, LYNNE MERYL (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MERYL
Last Name:MOFENSON
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 1:15117 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4333
Mailing Address - Country:US
Mailing Address - Phone:301-236-9319
Mailing Address - Fax:
Practice Address - Street 1:15117 TIMBERLAKE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4333
Practice Address - Country:US
Practice Address - Phone:301-236-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics