Provider Demographics
NPI:1982695805
Name:LYNCH, ELLEN MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:73D WINTHROP AVE
Mailing Address - Street 2:PLAZA 114
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3716
Mailing Address - Country:US
Mailing Address - Phone:978-686-3017
Mailing Address - Fax:978-685-4280
Practice Address - Street 1:73D WINTHROP AVE
Practice Address - Street 2:PLAZA 114
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3716
Practice Address - Country:US
Practice Address - Phone:978-686-3017
Practice Address - Fax:978-685-4280
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA78834208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20318Medicare UPIN
MAJ30454Medicare ID - Type Unspecified