Provider Demographics
NPI:1588766414
Name:CLEMENTS-NORTHLAND, LYNN A (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:A
Last Name:CLEMENTS-NORTHLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:695 DUTCHESS TPKE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6442
Mailing Address - Country:US
Mailing Address - Phone:888-647-5979
Mailing Address - Fax:845-454-3693
Practice Address - Street 1:695 DUTCHESS TPKE
Practice Address - Street 2:SUITE #105
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6442
Practice Address - Country:US
Practice Address - Phone:888-647-5979
Practice Address - Fax:845-454-3693
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME621612085R0202X
MDD00603112085R0202X
DCMD0342732085R0202X
VA01012347342085R0202X
NY230072085R0202X
NJ2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF64698Medicare UPIN