MEDICARE: DR. LYNWOOD INGRAM DAY PH.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	103T00000X	Psychologist	0810001098	VA

General Provider Information

NPI Number	:	1619047370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNWOOD INGRAM DAY PH.D.

Provider Business Mailing Address
First Line	:	4220 CYPRESS PARK DR
Second Line	:	SUITE B
City	:	ROANOKE
State	:	VA
Zip	:	24018-8440
Country	:	US
Telephone Number	:	540-772-1872
Fax Number	:	540-772-4830

Provider Business Practice Location Address
First Line	:	4220 CYPRESS PARK DR
Second Line	:	SUITE B
City	:	ROANOKE
State	:	VA
Zip	:	24018-8440
Country	:	US
Telephone Number	:	540-772-1872
Fax Number	:	540-772-4830

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/16/2018

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