Provider Demographics
NPI:1184734758
Name:LYNCH, JOAN A (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-4130
Mailing Address - Country:US
Mailing Address - Phone:304-529-6100
Mailing Address - Fax:304-529-0229
Practice Address - Street 1:1001 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2019
Practice Address - Country:US
Practice Address - Phone:304-529-6100
Practice Address - Fax:304-529-0229
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29316207KA0200X
WV16260207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY29316OtherLISENSE NUMBER
KY65930083Medicaid
KY64698772Medicaid
WV0044083000Medicaid
WV16260OtherLISENSE NUMBER
OHLO874442Medicaid
WV0011693000Medicaid
OHL0968403Medicaid
OHL0968403Medicaid
WVBL3192236OtherDEA
WV9263351Medicare ID - Type UnspecifiedGROUP #
WVF39127Medicare UPIN
KY65930083Medicaid
KY64698772Medicaid