Provider Demographics
NPI:1396829578
Name:LYNCH, GARY M (PT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3330 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1133
Mailing Address - Country:US
Mailing Address - Phone:410-638-0700
Mailing Address - Fax:
Practice Address - Street 1:2217 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2565
Practice Address - Country:US
Practice Address - Phone:410-638-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD544163-07OtherCAREFIRST BC/BS
MD5550494OtherAETNA PPO
MDS2720001OtherCAREFIRST HMO
MD2660218OtherAETNA HMO
MD544163-07OtherCAREFIRST BC/BS