Provider Demographics
NPI:1013911528
Name:COLAIACOVO, LYNN ANN (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:COLAIACOVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2501 SHENANGO VALLEY FWY
Mailing Address - Street 2:STE 1
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2536
Mailing Address - Country:US
Mailing Address - Phone:724-983-1820
Mailing Address - Fax:724-983-1822
Practice Address - Street 1:2501 SHENANGO VALLEY FWY
Practice Address - Street 2:STE 1
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2536
Practice Address - Country:US
Practice Address - Phone:724-983-1820
Practice Address - Fax:724-983-1822
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057934L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101761OtherUPMC
OH000000352669OtherANTHEM
GAP00204247OtherRAILROAD MEDICARE
PA1500331OtherGATEWAY
PA201894518OtherTRICARE
PA000662020OtherHIGHMARK
PA0016268820006Medicaid
PA000000160272OtherMEDPLUS