MEDICARE: LYNETTE S BORNMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35086130	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00228456	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275534331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE S BORNMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 20452
Second Line	:	CORPATH-CRED
City	:	COLUMBUS
State	:	OH
Zip	:	43220-0452
Country	:	US
Telephone Number	:	614-442-2406
Fax Number	:	614-442-2410

Provider Business Practice Location Address
First Line	:	3535 OLENTANGY RIVER RD
Second Line	:	RMH PATHOLOGY DEPT
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3908
Country	:	US
Telephone Number	:	614-566-4945
Fax Number	:	614-263-1056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/23/2014

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Directions to “ LYNETTE S BORNMAN MD” Practice Location

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