Provider Demographics
NPI:1366295875
Name:JOSEPH, LYNE ANDRAU LISSA (MD)
Entity type:Individual
Prefix:
First Name:LYNE ANDRAU
Middle Name:LISSA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:109 BRIDGE ST APT 201
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1246
Mailing Address - Country:US
Mailing Address - Phone:434-799-4488
Mailing Address - Fax:434-773-6977
Practice Address - Street 1:109 BRIDGE ST APT 201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1246
Practice Address - Country:US
Practice Address - Phone:434-799-4488
Practice Address - Fax:434-773-6977
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116039410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine