Provider Demographics
NPI:1891835740
Name:LYNCH, RODRIGUEZ AND KELLER, PA
Entity type:Organization
Organization Name:LYNCH, RODRIGUEZ AND KELLER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-7115
Mailing Address - Street 1:543 N SHIPLEY ST
Mailing Address - Street 2:STE E
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-2339
Mailing Address - Country:US
Mailing Address - Phone:302-629-7115
Mailing Address - Fax:302-629-0613
Practice Address - Street 1:543 N SHIPLEY ST
Practice Address - Street 2:STE E
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-2339
Practice Address - Country:US
Practice Address - Phone:302-629-7115
Practice Address - Fax:302-629-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989021969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038173Medicaid
DE1000038171Medicaid