Provider Demographics
NPI:1750368379
Name:LYNCH, JAMES HENRY IV (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:LYNCH
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:116 DEFENSE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7045
Mailing Address - Country:US
Mailing Address - Phone:410-505-0530
Mailing Address - Fax:
Practice Address - Street 1:116 DEFENSE HWY STE 203
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7045
Practice Address - Country:US
Practice Address - Phone:410-505-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0090677207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN