Provider Demographics
NPI:1962451773
Name:STOCKMAN, LYNNE WISER (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:WISER
Last Name:STOCKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:3235 BRIDGE RD
Practice Address - Street 2:STE 15
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1778
Practice Address - Country:US
Practice Address - Phone:757-606-1656
Practice Address - Fax:757-606-1657
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA10203737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962451773Medicaid
VA022351B28Medicare PIN
VAE77482Medicare UPIN