Healthcare Provider Details

I. General information

NPI: 1982976122
Provider Name (Legal Business Name): LYNNETTE NIEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 OLD GEORGETOWN RD
BETHESDA MD
20814-1620
US

IV. Provider business mailing address

10 CENTER DR, MSC 1109 BLDG 10/CRC, 1 EAST, RM 1-3140
BETHESDA MD
20892-1109
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-2400
  • Fax:
Mailing address:
  • Phone: 301-496-8935
  • Fax: 301-402-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number142923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: