Healthcare Provider Details

I. General information

NPI: 1528057940
Provider Name (Legal Business Name): LYNETTE JOAN MARGESSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD
LEBANON NH
03766-1937
US

IV. Provider business mailing address

18 OLD ETNA RD
LEBANON NH
03766-1937
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-3100
  • Fax:
Mailing address:
  • Phone: 603-650-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number159006
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number9703
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: