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General NPI Number Information
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NPI Number | 1023320611
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Entity Type | Individual
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Provider Name | LYNN MARIE CARLYLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 1551 PROFESSIONAL LN UNIT 150
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City | LONGMONT
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State | CO
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Zip | 80501-6908
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Country | US
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Telephone | 720-388-7760
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Fax | 720-405-4228
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Provider Business Mailing Address
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Address Line | 5318 5TH ST UNIT A
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City | BOULDER
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State | CO
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Zip | 80304-4818
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Country | US
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Telephone | 720-388-7760
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Fax | 720-405-4228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DR.0059129
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DR.0059129
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | DR.0059129
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301097300
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License Number State | MI
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