Provider Demographics
NPI:1013900224
Name:GINGERICH, LYNN D (PA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:D
Last Name:GINGERICH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-7390
Mailing Address - Fax:319-356-4609
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-7390
Practice Address - Fax:319-356-4609
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA49872OtherWELLMARK BCBS
IA49872OtherWELLMARK BCBS
R80995Medicare UPIN
IA970009410Medicare PIN