Provider Demographics
NPI:1457349441
Name:FLAGG, LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:
Last Name:FLAGG
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:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:8640 SUDLEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4420
Practice Address - Country:US
Practice Address - Phone:703-368-3161
Practice Address - Fax:703-368-2498
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248340207Q00000X
NJ25MA05458800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457349441Medicaid
NJ5530105Medicaid
NJG81998Medicare UPIN
NJ5530105Medicaid
NJ012008R63Medicare ID - Type Unspecified
NJ012008YBAWMedicare PIN