Provider Demographics
NPI:1811098684
Name:LYNCH, DELORES
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777
Mailing Address - Country:US
Mailing Address - Phone:508-674-3800
Mailing Address - Fax:508-675-9745
Practice Address - Street 1:1211 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777
Practice Address - Country:US
Practice Address - Phone:508-674-3800
Practice Address - Fax:508-675-9745
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21973225000000X
MACFM00962225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDS24649Medicaid
MA1538411Medicaid
MA382454OtherBCBS
RI78568OtherBCBS
645163OtherHARVARD PILGRIM
RIDS24649Medicaid