Provider Demographics
NPI:1265571947
Name:DWORSKY, LYNN STATON (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:STATON
Last Name:DWORSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:S
Other - Last Name:DWORSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7315 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ECHO
Mailing Address - State:MD
Mailing Address - Zip Code:20812-1118
Mailing Address - Country:US
Mailing Address - Phone:301-233-1305
Mailing Address - Fax:301-229-1904
Practice Address - Street 1:7315 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:GLEN ECHO
Practice Address - State:MD
Practice Address - Zip Code:20812-1118
Practice Address - Country:US
Practice Address - Phone:301-233-1305
Practice Address - Fax:301-229-1904
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD000313702084P0804X
MDD 000313702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95059Medicare UPIN