Provider Demographics
NPI:1164442828
Name:NIEMAN, LYNN M (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:878 FOX DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8613
Mailing Address - Country:US
Mailing Address - Phone:540-662-8336
Mailing Address - Fax:540-662-8593
Practice Address - Street 1:878 FOX DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-8613
Practice Address - Country:US
Practice Address - Phone:540-662-8336
Practice Address - Fax:540-662-8593
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600759207L00000X
OH35-098051207L00000X
NC2006-00759207LP2900X
VA0101257281207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI39184Medicare UPIN