Provider Demographics
NPI:1619298973
Name:WILSON, LYNN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:WILSON
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 1:5702 BELMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-3627
Mailing Address - Country:US
Mailing Address - Phone:330-727-4868
Mailing Address - Fax:
Practice Address - Street 1:400 N 17TH ST STE 300
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5052
Practice Address - Country:US
Practice Address - Phone:610-969-3500
Practice Address - Fax:610-969-3605
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018026207Q00000X, 207QG0300X, 207Q00000X
NY269893207Q00000X
NJ25MB09530700207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine