Provider Demographics
NPI:1922069046
Name:DIGENNARO, LYNNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MARIE
Last Name:DIGENNARO
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 1:3 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-3607
Mailing Address - Country:US
Mailing Address - Phone:315-829-2220
Mailing Address - Fax:315-829-2014
Practice Address - Street 1:3 CURTIS RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476-3607
Practice Address - Country:US
Practice Address - Phone:315-829-2220
Practice Address - Fax:315-829-2014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02158381Medicaid
NY02158381Medicaid
NYCC6697Medicare ID - Type Unspecified