Provider Demographics
NPI:1497725584
Name:LYNCH, THOMAS J JR (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:LYNCH
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:STE 300
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3880
Mailing Address - Country:US
Mailing Address - Phone:508-427-3668
Mailing Address - Fax:508-427-2610
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 105W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-427-3668
Practice Address - Fax:508-427-2610
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-05-07
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Provider Licenses
StateLicense IDTaxonomies
MA1657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP96846Medicare UPIN
MALY AP1994Medicare ID - Type Unspecified