Provider Demographics
NPI:1356407191
Name:LYNCH, TIMOTHY P
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:P
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1966
Mailing Address - Country:US
Mailing Address - Phone:814-899-3636
Mailing Address - Fax:814-899-9933
Practice Address - Street 1:4020 MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1966
Practice Address - Country:US
Practice Address - Phone:814-899-3636
Practice Address - Fax:814-899-9933
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000004966332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016291780003Medicaid
PA0016291780003Medicaid