Provider Demographics
NPI:1942264205
Name:LYNAM, MARILYN KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:KAY
Last Name:LYNAM
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 1:5500 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1772
Mailing Address - Country:US
Mailing Address - Phone:302-239-7755
Mailing Address - Fax:302-234-2735
Practice Address - Street 1:5500 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1772
Practice Address - Country:US
Practice Address - Phone:302-239-7755
Practice Address - Fax:302-234-2735
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100006882080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000091701Medicaid
DE0000091701Medicaid