Provider Demographics
NPI:1609856038
Name:GOLTRA, LYNNE BARTHOLOMEW (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:BARTHOLOMEW
Last Name:GOLTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNNE
Other - Middle Name:L
Other - Last Name:BARTHOLOMEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:781-487-3860
Mailing Address - Fax:617-487-3870
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 4 VINCENT OBGYN SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-2229
Practice Address - Fax:617-724-3498
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216410207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25700OtherBCBS MA
MA216410OtherTUFTS HEALTH PLAN
MA0189430Medicaid
MA0189430Medicaid
MA216410OtherTUFTS HEALTH PLAN