Provider Demographics
NPI:1801894837
Name:LYNCH, JEFFREY R (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
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 1:102 E CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4129
Mailing Address - Country:US
Mailing Address - Phone:856-988-6260
Mailing Address - Fax:856-988-6270
Practice Address - Street 1:102 E CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4129
Practice Address - Country:US
Practice Address - Phone:856-988-6260
Practice Address - Fax:856-988-6270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1830406Medicaid
NJ1830406Medicaid
NJ401624Medicare ID - Type Unspecified