Provider Demographics
NPI:1992747760
Name:SATTERLY, LYNN BETH
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:BETH
Last Name:SATTERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:BETH
Other - Last Name:SCHWARZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-464-4686
Mailing Address - Fax:
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:STE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-464-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01732567Medicaid
NY01732567Medicaid