MEDICARE: LYNN A. COLAIACOVO, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD057934L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD0239	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174541676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN A. COLAIACOVO, M.D., P.C.

Provider Business Mailing Address
First Line	:	2501 SHENANGO VALLEY FWY
Second Line	:	SUITE 1
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2536
Country	:	US
Telephone Number	:	724-983-1820
Fax Number	:	724-983-1822

Provider Business Practice Location Address
First Line	:	2501 SHENANGO VALLEY FWY
Second Line	:	SUITE 1
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2536
Country	:	US
Telephone Number	:	724-983-1820
Fax Number	:	724-983-1822

Authorized Official
Title or Position	:	OWNER
Name	:	LYNN ANNE COLAIACOVO
Credential	:	M.D.
Telephone Number	:	724-983-1820

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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