Provider Demographics
NPI:1720147861
Name:KLEIN, LYNN MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MICHELE
Last Name:KLEIN
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 1:50 MONUMENT ROAD
Mailing Address - Street 2:THIRD FLOOR SUITE 301
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1716
Mailing Address - Country:US
Mailing Address - Phone:610-668-2570
Mailing Address - Fax:610-668-2808
Practice Address - Street 1:50 MONUMENT RD
Practice Address - Street 2:THIRD FLOOR SUITE 301
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1723
Practice Address - Country:US
Practice Address - Phone:610-668-2570
Practice Address - Fax:610-668-2808
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049494L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF54075Medicare UPIN
PA740094T1TMedicare ID - Type Unspecified