Provider Demographics
NPI:1659423440
Name:LYNCH, GREGORY PAUL (CPO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:LYNCH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3614
Mailing Address - Country:US
Mailing Address - Phone:610-373-6860
Mailing Address - Fax:610-373-6860
Practice Address - Street 1:114 N 9TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:610-373-6860
Practice Address - Fax:610-373-6860
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA335E00000X
PA6000003088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0778890001Medicare NSC