MEDICARE: DR. LYNN LYVONN ESHLEMAN MD

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	207R00000X	Internal Medicine Physician	MA227278	MA

General Provider Information

NPI Number	:	1356398119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN LYVONN ESHLEMAN MD

Provider Business Mailing Address
First Line	:	91 5TH ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02141-1750
Country	:	US
Telephone Number	:	617-876-4344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 CAMBRIDGE ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-4308
Country	:	US
Telephone Number	:	617-876-4344
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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