Provider Demographics
NPI:1528043262
Name:VALENA, LYNN G (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:G
Last Name:VALENA
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 1:2600 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5263
Mailing Address - Country:US
Mailing Address - Phone:765-254-5602
Mailing Address - Fax:765-254-5603
Practice Address - Street 1:2600 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5263
Practice Address - Country:US
Practice Address - Phone:765-254-5602
Practice Address - Fax:765-254-5603
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030410A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100277960Medicaid
IN000000378437OtherBC/BS #
IN000000507764OtherBCBS UNDER NEW TAX ID
IN200839660AOtherMEDICAID GRP #
IN610545900OtherACS
IN200839660AOtherMEDICAID GRP #
IN610545900OtherACS
INC25995Medicare UPIN
IN110181403Medicare ID - Type UnspecifiedMEDICARE RR