Provider Demographics
NPI:1265401129
Name:CASPER, LYNNE MARCELLE (DPM)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MARCELLE
Last Name:CASPER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1385
Mailing Address - Country:US
Mailing Address - Phone:610-279-3080
Mailing Address - Fax:610-292-8384
Practice Address - Street 1:190 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1385
Practice Address - Country:US
Practice Address - Phone:610-279-3080
Practice Address - Fax:610-292-8384
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC00341L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-2969552OtherTAX ID #
23-2969552OtherTAX ID #
PA021782Medicare ID - Type UnspecifiedGROUP MEDICARE #
PA600618MT2Medicare ID - Type UnspecifiedINDIV MEDICARE #
U10514Medicare UPIN