Provider Demographics
NPI:1447365804
Name:DEUTSCH, LYNN HERKOWITZ (DO)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:HERKOWITZ
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 KERSEY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3055
Mailing Address - Country:US
Mailing Address - Phone:240-353-5555
Mailing Address - Fax:301-770-4762
Practice Address - Street 1:6205 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3906
Practice Address - Country:US
Practice Address - Phone:301-770-4761
Practice Address - Fax:301-770-4762
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH387402084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD361521900Medicaid
MD361521900Medicaid
MDC89248Medicare UPIN