Basic Information
| Provider Information | |||||||||
| NPI: | 1932275229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDOS | ||||||||
| FirstName: | LYNN | ||||||||
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| Credential: | CRPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MERIDIAN BLVD | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103724957 | ||||||||
| FaxNumber: | 6103723117 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 N RICHMOND ST | ||||||||
| Address2: | |||||||||
| City: | FLEETWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195221058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109440464 | ||||||||
| FaxNumber: | 6109449733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| 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 | UP001682C | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.