Basic Information
| Provider Information | |||||||||
| NPI: | 1528126844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASARDA | ||||||||
| FirstName: | LYNNANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 FLORAL DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198103836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025291010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 176 S NEW MIDDLETOWN RD | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106273690 | ||||||||
| FaxNumber: | 6106273684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | MD042840E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001567370 | 05 | PA | MEDICAID |