Basic Information
| Provider Information | |||||||||
| NPI: | 1063413599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEA | ||||||||
| FirstName: | LYN | ||||||||
| MiddleName: | NGUYEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 LUBRANO DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102665852 | ||||||||
| FaxNumber: | 4102665095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 05/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H0058097 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8110689 | 01 | MD | MAMSI PRIMARY CARE | OTHER | 0073009 | 01 | MD | CIGNA PIN NUMBER | OTHER | 80184145 | 01 | MD | RAILROAD MEDICARE | OTHER | 2981630 | 01 | MD | AETNA CAPITATED | OTHER | 404150000 | 05 | MD | MEDICAID | 2110689 | 01 | MD | MAMSI SPECIALIST | OTHER | 615698-01 | 01 | MD | CAREFIRST RENDERING | OTHER | 7744382 | 01 | MD | AETNA FEE FOR SERVICE | OTHER | 014378 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 7605-0050 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | P15500 | 01 | MD | CAREFIRST MPOS | OTHER |