Provider Demographics
NPI:1063477917
Name:LYNCH, GARRETT JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:JOHN
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 1:2003 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3088
Mailing Address - Country:US
Mailing Address - Phone:410-573-2530
Mailing Address - Fax:410-573-2536
Practice Address - Street 1:2003 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3088
Practice Address - Country:US
Practice Address - Phone:410-573-2530
Practice Address - Fax:410-573-2536
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32629207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76761Medicare UPIN
MD710CMedicare ID - Type UnspecifiedMEDICARE-ANNE ARUNDEL CO.
MD000J68A13Medicare ID - Type UnspecifiedMEDICARE-PRINCE GEORGE CO