Provider Demographics
NPI:1023320611
Name:CARLYLE, LYNN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:CARLYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 5TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4818
Mailing Address - Country:US
Mailing Address - Phone:720-388-7760
Mailing Address - Fax:720-405-4228
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 150
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6908
Practice Address - Country:US
Practice Address - Phone:720-388-7760
Practice Address - Fax:720-405-4228
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059129207RC0000X, 207R00000X, 207RI0011X
MI4301097300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000150154Medicaid