Provider Demographics
NPI:1689668766
Name:LYNCH, GREGORY J (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:841 HOSPITAL RD STE 2300
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3699
Practice Address - Country:US
Practice Address - Phone:724-349-7820
Practice Address - Fax:724-349-8816
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005328L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009622090005Medicaid
PA102889Medicare PIN
PA0009622090005Medicaid