Provider Demographics
NPI:1700833654
Name:LYNAGH, ADELE S (MD)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:S
Last Name:LYNAGH
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 63436
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3436
Mailing Address - Country:US
Mailing Address - Phone:864-848-9555
Mailing Address - Fax:864-999-3713
Practice Address - Street 1:1 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3955
Practice Address - Country:US
Practice Address - Phone:864-255-1000
Practice Address - Fax:864-269-1361
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24403207L00000X, 207LP2900X
GA035920207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC244033Medicaid
GA000657665CMedicaid
SCP00353627Medicare PIN
SCG121493157Medicare PIN
SC244033Medicaid
GA05BDKRDMedicare PIN
GA000657665CMedicaid