1972555175 NPI number — DR. LYNETTE D. CHARITY MD

Table of content: DR. LYNETTE D. CHARITY MD (NPI 1972555175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972555175 NPI number — DR. LYNETTE D. CHARITY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARITY
Provider First Name:
LYNETTE
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972555175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COLUMBIA POINT DR
Provider Second Line Business Mailing Address:
UNIT A112
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-4371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-713-7685
Provider Business Mailing Address Fax Number:
509-713-7686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COLUMBIA POINT DR
Provider Second Line Business Practice Location Address:
UNIT A112
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-713-7685
Provider Business Practice Location Address Fax Number:
509-713-7686
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD00021059 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 36475 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 0101031521 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 10683 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1115971 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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