Healthcare Provider Details

I. General information

NPI: 1366992653
Provider Name (Legal Business Name): ROBERT S LYNCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 HAZEL DELL RD
NOBLESVILLE IN
46062-7066
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-922-2090
  • Fax: 317-574-1875
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002131A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: