Provider Demographics
NPI:1710691332
Name:LYNCH, DEREK ANTHONY
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ANTHONY
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 WEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1662
Mailing Address - Country:US
Mailing Address - Phone:215-896-2969
Mailing Address - Fax:
Practice Address - Street 1:392 WEXLEY DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1662
Practice Address - Country:US
Practice Address - Phone:215-896-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach