Provider Demographics
NPI:1578774873
Name:LYNCH, MATTHEW CLYDE (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CLYDE
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4104 STATE HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:PERTH
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6202
Mailing Address - Country:US
Mailing Address - Phone:518-883-8620
Mailing Address - Fax:518-883-8229
Practice Address - Street 1:4104 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6202
Practice Address - Country:US
Practice Address - Phone:518-883-6339
Practice Address - Fax:518-883-5691
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY257081-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400017001OtherBSH NE NY
NYJ400023989Medicare PIN