Provider Demographics
NPI:1750325551
Name:CLEARY, LYNN M (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-5240
Mailing Address - Fax:315-464-3892
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-5240
Practice Address - Fax:315-464-3892
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-12-02
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Provider Licenses
StateLicense IDTaxonomies
NY162168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00960187Medicaid
NY39759LMedicare PIN
NYP110061791Medicare PIN