Provider Demographics
NPI:1699139436
Name:BANE, LYNSIE ACACIA (MD)
Entity type:Individual
Prefix:
First Name:LYNSIE
Middle Name:ACACIA
Last Name:BANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 DILEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9612
Mailing Address - Country:US
Mailing Address - Phone:614-835-3838
Mailing Address - Fax:
Practice Address - Street 1:7901 DILEY RD STE 200
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-835-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine