Healthcare Provider Details

I. General information

NPI: 1386930519
Provider Name (Legal Business Name): LYNN MARIE WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 CORTLAND DR BOX 367
NEW PARIS PA
15554-7706
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-839-4108
  • Fax: 814-839-4845
Mailing address:
  • Phone: 814-410-8300
  • Fax: 814-410-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD452340
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: