Provider Demographics
NPI:1265551592
Name:YARBOROUGH, LYNN V (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:V
Last Name:YARBOROUGH
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:P.O. BOX 1257
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-1257
Mailing Address - Country:US
Mailing Address - Phone:301-218-8700
Mailing Address - Fax:301-218-9200
Practice Address - Street 1:2905 MITCHELLVILLE ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3953
Practice Address - Country:US
Practice Address - Phone:301-218-8700
Practice Address - Fax:301-218-9200
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4089502OtherAETNA
B94729Medicare UPIN
491599Medicare PIN