Provider Demographics
NPI:1962686204
Name:LYNN MCKINLEY-GRANT, MD, PC
Entity Type:Organization
Organization Name:LYNN MCKINLEY-GRANT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKINLEY-GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-941-8166
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1275
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-941-8166
Mailing Address - Fax:301-941-8025
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1275
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-941-8166
Practice Address - Fax:301-941-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00545Medicare PIN