Provider Demographics
NPI:1093787731
Name:DEVER, LYNN GARVIN (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:GARVIN
Last Name:DEVER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 STREET ROAD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-364-5800
Mailing Address - Fax:215-364-5899
Practice Address - Street 1:9122 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-331-1400
Practice Address - Fax:215-331-1272
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040628E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016188260009Medicaid
PA0016188260009Medicaid
G48110Medicare UPIN