Healthcare Provider Details

I. General information

NPI: 1750368379
Provider Name (Legal Business Name): JAMES HENRY LYNCH IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 DEFENSE HWY STE 203
ANNAPOLIS MD
21401-7045
US

IV. Provider business mailing address

116 DEFENSE HWY STE 203
ANNAPOLIS MD
21401-7045
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-0530
  • Fax:
Mailing address:
  • Phone: 410-505-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberD0090677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: