Provider Demographics
NPI:1336219476
Name:LYNCH, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
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 1:11711 NE 12TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2461
Mailing Address - Country:US
Mailing Address - Phone:425-899-4301
Mailing Address - Fax:
Practice Address - Street 1:11711 NE 12TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2461
Practice Address - Country:US
Practice Address - Phone:425-899-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0000290406174400000X
WI263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8456311Medicaid
WA177785OtherLABOR AND INDUSTRIES
WA8456311Medicaid
WAF16799Medicare UPIN