Basic Information
Provider Information | |||||||||
NPI: | 1124029301 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BIRKMEYER | ||||||||
FirstName: | LYNNE | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4022 ZUCK RD | ||||||||
Address2: |   | ||||||||
City: | ERIE | ||||||||
State: | PA | ||||||||
PostalCode: | 165064592 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8148775424 | ||||||||
FaxNumber: | 8148775423 | ||||||||
Practice Location | |||||||||
Address1: | 4022 ZUCK ROAD | ||||||||
Address2: | YOUR PEDIATRIC CONNECTION WEST | ||||||||
City: | ERIE | ||||||||
State: | PA | ||||||||
PostalCode: | 165064592 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8148775424 | ||||||||
FaxNumber: | 8148775423 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/10/2005 | ||||||||
LastUpdateDate: | 03/18/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 034397 | CT | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 034397 | VA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | MD442035 | PA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 010034397CT03 | 01 | CT | BLUECROSS/BLUE SHIELD | OTHER | 001343970 | 05 | CT |   | MEDICAID | 01034397 | 01 |   | CIGNA | OTHER | 0R4432 | 01 |   | HEALTHNET | OTHER | HAP143 | 01 |   | OXFORD | OTHER | 1528733 | 01 |   | UNITED HEALTHCARE | OTHER | 2602753 | 01 |   | GHI | OTHER | 343970 | 01 |   | CONNECTICARE | OTHER | 265500 | 01 |   | MVP | OTHER | 1025727420001 | 05 | PA |   | MEDICAID | 2396621 | 01 |   | AETNA | OTHER |