Provider Demographics
NPI:1558392621
Name:TALLEY, LYNN E (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DO
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 785116
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:302-731-2900
Mailing Address - Fax:302-731-1306
Practice Address - Street 1:4745 OGLETOWN STANTON RD STE 231
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2074
Practice Address - Country:US
Practice Address - Phone:302-731-2900
Practice Address - Fax:302-731-1306
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002144207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000584102Medicaid
DEB66291Medicare UPIN
DE0000584102Medicaid