Provider Demographics
NPI:1548207574
Name:LYNCH, LETITIA (PA)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7635 INTERACTIVE WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2732
Mailing Address - Country:US
Mailing Address - Phone:317-522-1266
Mailing Address - Fax:317-245-2308
Practice Address - Street 1:7635 INTERACTIVE WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2732
Practice Address - Country:US
Practice Address - Phone:317-522-1266
Practice Address - Fax:317-245-2308
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant