Provider Demographics
NPI:1881857761
Name:DUFFALO, LYNNAE H (MD)
Entity Type:Individual
Prefix:
First Name:LYNNAE
Middle Name:H
Last Name:DUFFALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNNAE
Other - Middle Name:D
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:617-638-4860
Mailing Address - Fax:617-536-8093
Practice Address - Street 1:4745 OGLETOWN-STANTON ROAD
Practice Address - Street 2:MAP 1, SUITE 220
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2074
Practice Address - Country:US
Practice Address - Phone:617-638-4860
Practice Address - Fax:617-536-8093
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433919207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist