Provider Demographics
NPI:1902841695
Name:COSLETT-CHARLTON, LYNNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:M
Last Name:COSLETT-CHARLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 N RIVER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2600
Mailing Address - Country:US
Mailing Address - Phone:570-288-6616
Mailing Address - Fax:570-288-6860
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-288-6616
Practice Address - Fax:570-288-6860
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065251L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017531050007Medicaid
PA123397Medicare ID - Type Unspecified
PAG91707Medicare UPIN