Provider Demographics
NPI:1306291646
Name:LYNCH, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 419402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9402
Mailing Address - Country:US
Mailing Address - Phone:855-290-1552
Mailing Address - Fax:336-774-6872
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4465
Practice Address - Country:US
Practice Address - Phone:540-741-2865
Practice Address - Fax:540-741-2868
Is Sole Proprietor?:No
Enumeration Date:2016-04-23
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173781363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care