Provider Demographics
NPI:1801908264
Name:MYERS, LYNN A (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2425
Mailing Address - Country:US
Mailing Address - Phone:814-371-4524
Mailing Address - Fax:814-371-0331
Practice Address - Street 1:89 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2425
Practice Address - Country:US
Practice Address - Phone:814-371-4524
Practice Address - Fax:814-371-0331
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417134208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018709250001Medicaid
PA0018709250002Medicaid
PA0018709250002Medicaid
PAB55292Medicare UPIN