Healthcare Provider Details

I. General information

NPI: 1669585170
Provider Name (Legal Business Name): MELANIE A LYNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE A CELESTE

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 PARK AVE STE 1-500
TRUMBULL CT
06611-3463
US

IV. Provider business mailing address

5520 PARK AVE STE 1-500
TRUMBULL CT
06611-3463
US

V. Phone/Fax

Practice location:
  • Phone: 203-254-2381
  • Fax: 203-337-8788
Mailing address:
  • Phone: 203-254-3070
  • Fax: 203-337-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-083052
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number67122
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: