Provider Demographics
NPI:1558455428
Name:SCHWARTZ, LYNNAE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNAE
Middle Name:
Last Name:SCHWARTZ
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 1:2118 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6535
Mailing Address - Country:US
Mailing Address - Phone:267-519-3377
Mailing Address - Fax:
Practice Address - Street 1:2118 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6535
Practice Address - Country:US
Practice Address - Phone:267-519-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAK000115171100000X
PAMD433698207LP3000X
DCMD22135207XP3100X
PA433698208000000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No171100000XOther Service ProvidersAcupuncturist
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020913200001Medicaid
PA177629EJLOtherMEDICARE PTAN
PA177629EJLOtherMEDICARE PTAN