Provider Demographics
NPI:1184896755
Name:LYNCH, PETRA S (MD)
Entity type:Individual
Prefix:MRS
First Name:PETRA
Middle Name:S
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1031 LOFTIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2981
Mailing Address - Country:US
Mailing Address - Phone:757-736-9860
Mailing Address - Fax:757-240-5537
Practice Address - Street 1:1031 LOFTIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2981
Practice Address - Country:US
Practice Address - Phone:757-736-9860
Practice Address - Fax:757-240-5537
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101276307207R00000X, 207RC0000X, 207RI0011X
PAMD445974207RC0000X, 207RI0011X
AL38293207RC0000X
GA86479207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027360950002Medicaid
PA1027360950002Medicaid