Basic Information
| Provider Information | |||||||||
| NPI: | 1063694289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNOLLY | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | SHAPIRO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHAPIRO | ||||||||
| OtherFirstName: | LYNN | ||||||||
| OtherMiddleName: | ROCHELLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1223 16TH ST | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904041217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105826240 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1223 16TH ST | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904041217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105826240 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | A97034 | CA | N | Hospitals | General Acute Care Hospital | Critical Access | 207RG0100X | A97034 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.