Provider Demographics
NPI:1699986877
Name:LYNCH-BIASI, MARTHA ANNE (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:LYNCH-BIASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ANNE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30415 TELLURIDE LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9564
Mailing Address - Country:US
Mailing Address - Phone:303-679-9615
Mailing Address - Fax:
Practice Address - Street 1:30415 TELLURIDE LN
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9564
Practice Address - Country:US
Practice Address - Phone:303-679-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32792207R00000X
CODR.0032792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327923Medicaid
CO01327923Medicaid
COF70242Medicare UPIN