Provider Demographics
NPI:1760488621
Name:LYNCH, MARC E (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2492
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-2492
Mailing Address - Country:US
Mailing Address - Phone:909-591-0843
Mailing Address - Fax:909-591-7226
Practice Address - Street 1:5365 WALNUT AVE STE P
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-591-0843
Practice Address - Fax:909-591-7226
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2020-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6261207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX62610Medicaid
CA00AX62611Medicaid
CAF45895Medicare UPIN
CA020A62610Medicare ID - Type Unspecified
CA00AX62611Medicaid