Provider Demographics
NPI:1922027705
Name:LYNCH, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 DIXIE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1727
Mailing Address - Country:US
Mailing Address - Phone:502-430-6223
Mailing Address - Fax:502-369-5229
Practice Address - Street 1:5129 DIXIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1727
Practice Address - Country:US
Practice Address - Phone:502-430-6223
Practice Address - Fax:502-369-5229
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050636A208VP0014X, 207LP2900X
KY50736208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000300418OtherANTHEM
KY7100349030Medicaid
KY000001189449OtherANTHEM
IN201269210Medicaid
KY000001189449OtherANTHEM
OH2418799Medicaid