Provider Demographics
NPI:1699776781
Name:LYNCH, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 MULLICA HILL ROAD
Mailing Address - Street 2:OUTPATIENT BLDG. 3RD FLOOR
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062
Mailing Address - Country:US
Mailing Address - Phone:856-508-3708
Mailing Address - Fax:856-221-4103
Practice Address - Street 1:698 MULLICA HILL RD BLDG 3
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4452
Practice Address - Country:US
Practice Address - Phone:856-508-3708
Practice Address - Fax:856-221-4103
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05942300208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6748601Medicaid
NJ6748601Medicaid
147108SLRMedicare ID - Type Unspecified