Provider Demographics
NPI:1043439599
Name:LYNCH, DOUGLAS STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STUART
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1328
Mailing Address - Country:US
Mailing Address - Phone:732-333-1117
Mailing Address - Fax:732-845-4671
Practice Address - Street 1:124 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1328
Practice Address - Country:US
Practice Address - Phone:732-333-1117
Practice Address - Fax:732-845-4671
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00268600213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU91529Medicare UPIN
NJ060692SGCMedicare PIN