Provider Demographics
NPI:1659390482
Name:LYNN, JENNIFER RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTH
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:424 CONESTOGA RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1010
Mailing Address - Country:US
Mailing Address - Phone:610-251-9257
Mailing Address - Fax:
Practice Address - Street 1:100 CHURCH RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2316
Practice Address - Country:US
Practice Address - Phone:610-679-7616
Practice Address - Fax:215-482-8456
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA421687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081473G52Medicare ID - Type Unspecified
PAI01754Medicare UPIN