Provider Demographics
NPI:1609946755
Name:MCLAMB, LYNETTE TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:TERESA
Last Name:MCLAMB
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:FOREST KNOLLS
Mailing Address - State:CA
Mailing Address - Zip Code:94933-0400
Mailing Address - Country:US
Mailing Address - Phone:415-717-3016
Mailing Address - Fax:415-482-6883
Practice Address - Street 1:1033 3RD STREET
Practice Address - Street 2:KAISER PERMANENTE ADULT MEDICINE
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-482-6825
Practice Address - Fax:415-482-6883
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G624550Medicaid
CA00G624552Medicare PIN
CAF09260Medicare UPIN