Provider Demographics
NPI:1154676104
Name:LYNCH, JOHN (MPAS PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MPAS PA-C
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:SHAW
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5659 PARKWAY DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3792
Mailing Address - Country:US
Mailing Address - Phone:804-210-1005
Mailing Address - Fax:804-210-1009
Practice Address - Street 1:4179 AMBASSADOR CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1450
Practice Address - Country:US
Practice Address - Phone:757-345-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant