Provider Demographics
NPI:1326030388
Name:DEVLIN-PHINNEY, LORI A (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:DEVLIN-PHINNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:DEVLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-272-5817
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:411 E CHESTNUT ST # 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-0982
Practice Address - Fax:502-588-0987
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY027512080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200521280Medicaid
KY64107071Medicaid