Provider Demographics
NPI:1700969813
Name:MILLER, LYNN E (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:214 TILDEN DR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1630
Mailing Address - Country:US
Mailing Address - Phone:315-437-8204
Mailing Address - Fax:
Practice Address - Street 1:1 RUDOLPH ROAD,
Practice Address - Street 2:SUNY OSWEGO, BUILDING 10, MARY WALKER HEALTH CENTER
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-312-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE41766Medicare UPIN