Provider Demographics
NPI:1306943477
Name:LYNE, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:LYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-281-1757
Mailing Address - Fax:412-281-7274
Practice Address - Street 1:12311 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:724-884-0885
Practice Address - Fax:724-884-0881
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048283L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10931466OtherCAQH
PA001694390Medicaid
PA0016943900009Medicaid
340015844OtherRAILROAD MEDICARE
PA006780MCMedicare PIN