MEDICARE: LYNN STATON DWORSKY M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	D00031370	MD
2	2084P0800X	Psychiatry Physician	D 00031370	MD

General Provider Information

NPI Number	:	1265571947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN STATON DWORSKY M.D.

Provider Business Mailing Address
First Line	:	7315 COLUMBIA AVE
Second Line	:
City	:	GLEN ECHO
State	:	MD
Zip	:	20812-1118
Country	:	US
Telephone Number	:	301-233-1305
Fax Number	:	301-229-1904

Provider Business Practice Location Address
First Line	:	7315 COLUMBIA AVE
Second Line	:
City	:	GLEN ECHO
State	:	MD
Zip	:	20812-1118
Country	:	US
Telephone Number	:	301-233-1305
Fax Number	:	301-229-1904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/04/2025

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