Healthcare Provider Details

I. General information

NPI: 1720480858
Provider Name (Legal Business Name): LYNNE AMY BOOTH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST
LANCASTER PA
17602
US

IV. Provider business mailing address

5360 LINCOLN HWY STE 15
GAP PA
17527-9461
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-4940
  • Fax:
Mailing address:
  • Phone: 717-442-8111
  • Fax: 717-442-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD474143
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: