Provider Demographics
NPI:1487609160
Name:STREET, LYNN (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:STREET
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 1:100 YORK ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-787-3588
Mailing Address - Fax:203-777-3767
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-787-3588
Practice Address - Fax:203-777-3767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010031188CT05OtherANTHEM BCBS
755255OtherCONNECTCARE
9389988OtherCIGNA
2786505OtherAETNA HEALTH PLAN
2V6941OtherHEALTHNET
CT001311886Medicaid
P2685931OtherOXFORD
755255OtherCONNECTCARE
P2685931OtherOXFORD