Provider Demographics
NPI:1063413599
Name:DEA, LYN NGUYEN (DO)
Entity type:Individual
Prefix:DR
First Name:LYN
Middle Name:NGUYEN
Last Name:DEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:129 LUBRANO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7566
Practice Address - Country:US
Practice Address - Phone:410-266-5852
Practice Address - Fax:410-266-5095
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0073009OtherCIGNA PIN NUMBER
MD7744382OtherAETNA FEE FOR SERVICE
MD2981630OtherAETNA CAPITATED
MD8110689OtherMAMSI PRIMARY CARE
MD80184145OtherRAILROAD MEDICARE
MDP15500OtherCAREFIRST MPOS
MD2110689OtherMAMSI SPECIALIST
MD7605-0050OtherCAREFIRST BLUECHOICE
MD615698-01OtherCAREFIRST RENDERING
MD014378OtherJHHC PROVIDER NUMBER
MD404150000Medicaid
MD8110689OtherMAMSI PRIMARY CARE
MD7744382OtherAETNA FEE FOR SERVICE