MEDICARE: DR. LYNNE MARIE DEBRAKELEER DO

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	207L00000X	Anesthesiology Physician	OS007447L	PA

General Provider Information

NPI Number	:	1477548998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNE MARIE DEBRAKELEER DO

Provider Business Mailing Address
First Line	:	2017 CEDARS HILL RD
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446
Country	:	US
Telephone Number	:	610-584-0584
Fax Number	:	610-584-0584

Provider Business Practice Location Address
First Line	:	123 W GERMANTOWN PIKE
Second Line	:	SUITE 2
City	:	EAST NORRITON
State	:	PA
Zip	:	19401
Country	:	US
Telephone Number	:	610-278-7456
Fax Number	:	610-278-7457

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	02/10/2015

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