MEDICARE: DR. LYNETTE MARIE SHOLL 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	207ZP0101X	Anatomic Pathology Physician	222476	MA

General Provider Information

NPI Number	:	1417015017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNETTE MARIE SHOLL M.D.

Provider Business Mailing Address
First Line	:	75 FRANCIS STREET
Second Line	:	DEPARTMENT OF PATHOLOGY
City	:	BOSTON
State	:	MA
Zip	:	02115-6028
Country	:	US
Telephone Number	:	617-732-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 FRANCIS STREET
Second Line	:	DEPARTMENT OF PATHOLOGY
City	:	BOSTON
State	:	MA
Zip	:	02115-6028
Country	:	US
Telephone Number	:	617-732-7510
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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