Provider Demographics
NPI:1689846867
Name:CHAMBERLIN, LYNN M (PA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1040
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:54 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANDOR
Practice Address - State:NY
Practice Address - Zip Code:13743-1617
Practice Address - Country:US
Practice Address - Phone:607-659-7272
Practice Address - Fax:607-659-4242
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03138121Medicaid