Provider Demographics
NPI: | 1245464437 |
---|---|
Name: | CHOUHFEH, LYNN (MD) |
Entity type: | Individual |
Prefix: | MRS |
First Name: | LYNN |
Middle Name: | |
Last Name: | CHOUHFEH |
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: | 1300 YORK ROAD |
Mailing Address - Street 2: | BLDG. A SUITE 300 |
Mailing Address - City: | LUTHERVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21093 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-828-4629 |
Mailing Address - Fax: | 410-828-4783 |
Practice Address - Street 1: | 1300 YORK ROAD |
Practice Address - Street 2: | BLDG. A SUITE 300 |
Practice Address - City: | LUTHERVILLE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21093 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-828-4629 |
Practice Address - Fax: | 410-828-4783 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-05-04 |
Last Update Date: | 2018-02-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 0436234 | 2084N0400X |
390200000X | ||
MD | D0083006 | 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 847503200 | Medicaid |