Provider Demographics
NPI:1598734253
Name:LYNCH, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 FODEN RD., WEST
Mailing Address - Street 2:SOUTH 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:84 MARGINAL WAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2443
Practice Address - Country:US
Practice Address - Phone:207-774-4092
Practice Address - Fax:207-523-8596
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-10-29
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Provider Licenses
StateLicense IDTaxonomies
ME010575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME257560099Medicaid
030224OtherANTHEM
1042474OtherAETNA