Provider Demographics
NPI:1306074760
Name:RYNN, LISA ANN (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:RYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4055 RIDGE AVE
Mailing Address - Street 2:APT 1305
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1576
Mailing Address - Country:US
Mailing Address - Phone:412-720-7483
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:OFFICE OF MEDICAL AND ACADEMIC AFFAIR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-5127
Practice Address - Fax:215-427-4805
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT196035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics