Provider Demographics
NPI:1306042627
Name:LYNCH, TERESA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANNE
Other - Last Name:OVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:245 GOVERNORS DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-2700
Mailing Address - Country:US
Mailing Address - Phone:562-659-8892
Mailing Address - Fax:256-265-9910
Practice Address - Street 1:245 GOVERNORS DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-2700
Practice Address - Country:US
Practice Address - Phone:562-659-8892
Practice Address - Fax:256-265-9910
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33005208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035310Medicaid
KY7100171080Medicaid
KYK009570Medicare PIN
KYK009571Medicare PIN