Healthcare Provider Details

I. General information

NPI: 1285655381
Provider Name (Legal Business Name): MAIN STREET MEDICAL ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W MAIN ST
MT PLEASANT PA
15666-1833
US

IV. Provider business mailing address

525 W MAIN ST
MT PLEASANT PA
15666-1833
US

V. Phone/Fax

Practice location:
  • Phone: 724-547-4536
  • Fax: 724-547-3799
Mailing address:
  • Phone: 724-547-4536
  • Fax: 724-547-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012524
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD434385
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037152L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD030863E
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051424
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010951
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD017110E
License Number StatePA

VIII. Authorized Official

Name: RICHARD EUGENE LYNN
Title or Position: PRESIDENT
Credential: MD
Phone: 724-547-4536