Provider Demographics
NPI:1558380345
Name:MILLER, LYNNE EWING (MD)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:EWING
Last Name:MILLER
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 1:509 ROUTE 312
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2830
Mailing Address - Country:US
Mailing Address - Phone:845-278-7107
Mailing Address - Fax:
Practice Address - Street 1:509 ROUTE 312
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2830
Practice Address - Country:US
Practice Address - Phone:845-278-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028759207R00000X
NY173520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61425Medicare UPIN