Provider Demographics
NPI:1740253608
Name:FLYNN, CAROLYN JEAN (DO)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:JEAN
Other - Last Name:BLEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 CAMPUS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-536-4334
Mailing Address - Fax:540-536-4333
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-536-4334
Practice Address - Fax:540-536-4333
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9213207Q00000X
VA0102204226207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273685300Medicaid
FL30072OtherBCBS
FL273685300Medicaid
FLI37305Medicare UPIN