Provider Demographics
NPI:1962476325
Name:MROZ, LYNNE A (MD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:MROZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:A
Other - Last Name:ODORISIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:TOWER 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-7979
Practice Address - Fax:215-456-8539
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048771L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00141039000003Medicaid
F30639Medicare UPIN
0000021834Medicare ID - Type Unspecified