Provider Demographics
NPI:1104915073
Name:HAGELIN, LYNNE (PSYCHIATRIST)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:HAGELIN
Suffix:
Gender:F
Credentials:PSYCHIATRIST
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:
Other - Last Name:HAGELIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHIATRIST
Mailing Address - Street 1:123 N DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1908
Mailing Address - Country:US
Mailing Address - Phone:302-530-0445
Mailing Address - Fax:302-656-5837
Practice Address - Street 1:123 N DUPONT RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1908
Practice Address - Country:US
Practice Address - Phone:302-530-0445
Practice Address - Fax:302-656-5837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100041552084P0800X
PAMD 045171E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10004155OtherLICENSE
F01402Medicare UPIN