Provider Demographics
NPI:1700974763
Name:WERNER, LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:WERNER
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 1:385 ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6729
Mailing Address - Country:US
Mailing Address - Phone:207-535-1200
Mailing Address - Fax:207-535-1249
Practice Address - Street 1:385 ROUTE 1
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6729
Practice Address - Country:US
Practice Address - Phone:207-535-1200
Practice Address - Fax:207-535-1249
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028103207P00000X
ME017970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000474801BMedicaid
ME1700974763Medicaid
GA93BDBWKMedicare ID - Type Unspecified
GA000474801BMedicaid