Provider Demographics
NPI:1851372551
Name:LYNAM, DANIEL H (PA C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:H
Last Name:LYNAM
Suffix:
Gender:M
Credentials:PA C
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Mailing Address - Street 1:1833 PEARTREE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7817
Mailing Address - Country:US
Mailing Address - Phone:252-331-7773
Mailing Address - Fax:
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE G
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-5424
Practice Address - Fax:252-335-1077
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102249363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67455Medicare UPIN