Provider Demographics
NPI:1841209541
Name:SYDOR, LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SYDOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:SYDOR
Other - Last Name:ISRAELIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-652-8310
Mailing Address - Fax:
Practice Address - Street 1:1501 TROUSDALE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4506
Practice Address - Country:US
Practice Address - Phone:650-652-8310
Practice Address - Fax:650-652-8311
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75923207N00000X
CAG88041207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30540OtherBLUE CROSS
MA0014524OtherNEIGHBORHOOD HEALTH PLAN
MA1968447-002OtherCIGNA
MAPD179OtherHARVARD PILGRIM
MA3179541Medicaid
MA075923OtherTUFTS HEALTH PLAN
MA075923OtherTUFTS HEALTH PLAN
MAF80447Medicare UPIN