Provider Demographics
NPI:1962491415
Name:LUGINBUHL, LYNN M (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:LUGINBUHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:LUGINBUHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:446 COBBLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9091
Mailing Address - Country:US
Mailing Address - Phone:802-318-3901
Mailing Address - Fax:
Practice Address - Street 1:305 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6273
Practice Address - Country:US
Practice Address - Phone:208-381-7330
Practice Address - Fax:208-381-7331
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009180208000000X
IDM-134352080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005349Medicaid
VT1005349Medicaid