Basic Information
| Provider Information | |||||||||
| NPI: | 1114918166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FANN | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 LINDEN PONDS WAY | ||||||||
| Address2: | |||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020433791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815347100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 LINDEN PONDS WAY | ||||||||
| Address2: | |||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020433791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815347100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 154023 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0021092 | 01 | MA | NEIGHBORHOOD HLTH PLAN | OTHER | 042297845 | 01 | MA | GIC UNICARE | OTHER | 154023 | 01 | MA | TUFTS | OTHER | 68861 | 01 | MA | HVD PILGRIM HEALTH CARE | OTHER | 042297845 | 01 | MA | HCVM | OTHER | 042297845 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | 33931 | 01 | MA | FALLON | OTHER | J17806 | 01 | MA | BCBS | OTHER | 154023 | 01 | MA | SECURE HORIZONS | OTHER | 5452575 | 01 | MA | AETNA | OTHER | 042297845 | 01 | MA | DOC FIRST | OTHER | B10358401 | 01 | MA | CIGNA | OTHER | 042297845 | 01 | MA | UNITED HEALTH CARE | OTHER | 042297845 | 01 | MA | GREAT WEST HEALTH CARE | OTHER | 3171434 | 05 | MA | MEDICAID | 042297845 | 01 | MA | TRICARE | OTHER |