Provider Demographics
NPI:1437960556
Name:SMITH, LYNN M
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 MARSHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAWTONS
Mailing Address - State:NY
Mailing Address - Zip Code:14091-9712
Mailing Address - Country:US
Mailing Address - Phone:716-432-3296
Mailing Address - Fax:
Practice Address - Street 1:144 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1560
Practice Address - Country:US
Practice Address - Phone:716-298-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9892462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology