Individual
JEROME RUDOLPH LYN-SUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(717) 531-8887
(717) 531-4729
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
D65607
MD
208600000X
Surgery Physician
Primary
MD440535
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024785260001
—
PA
05
—
311460
—
SC
01
—
5551
MEDICARE GROUP #
SC
01
—
GP4953
MEDICAID GROUP #
SC
01
—
P00775529
RAILROAD MEDICARE ID-AFTER 5/1/2009
SC
Enumeration date
05/15/2007
Last updated
11/16/2018
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