Healthcare Provider Details

I. General information

NPI: 1114918166
Provider Name (Legal Business Name): LYNDA M FANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LINDEN PONDS WAY
HINGHAM MA
02043-3791
US

IV. Provider business mailing address

300 LINDEN PONDS WAY
HINGHAM MA
02043-3791
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7100
  • Fax:
Mailing address:
  • Phone: 781-534-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number154023
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: