Provider Demographics
NPI:1336116276
Name:LYNCH, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
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 1:460 MYLAN PARK LANE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2243
Mailing Address - Country:US
Mailing Address - Phone:304-983-7766
Mailing Address - Fax:304-983-7768
Practice Address - Street 1:460 MYLAN PARK LANE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2243
Practice Address - Country:US
Practice Address - Phone:304-983-7766
Practice Address - Fax:304-983-7768
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16960208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0113529001Medicaid
WV000181128OtherMT STATE BCBS
WV000181128OtherMT STATE BCBS
WV0113529001Medicaid
WV0737833Medicare PIN