Provider Demographics
NPI:1356364145
Name:LYNCH, JOHN III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LYNCH
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 PRESTIGE PL
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3794
Mailing Address - Country:US
Mailing Address - Phone:937-752-2306
Mailing Address - Fax:937-522-7626
Practice Address - Street 1:540 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6401
Practice Address - Country:US
Practice Address - Phone:937-298-8058
Practice Address - Fax:937-298-5638
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01057624A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051334Medicaid
OHH017351Medicare PIN
OHH017350Medicare PIN
OHH017353Medicare PIN