Provider Demographics
NPI:1982647350
Name:LYNCH, ANDREW KEANE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KEANE
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 1:1750 112TH AVE NE
Mailing Address - Street 2:SUITE D258
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3752
Mailing Address - Country:US
Mailing Address - Phone:425-451-2272
Mailing Address - Fax:425-451-1052
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUITE D258
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:425-451-2272
Practice Address - Fax:425-451-1052
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60105638208100000X
NC2006-00628208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904009Medicaid
NC2051859Medicare PIN
NCI54767Medicare UPIN