Healthcare Provider Details

I. General information

NPI: 1316203763
Provider Name (Legal Business Name): TARA ANN LYNCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE STE 2
ALBANY NY
12208-3797
US

IV. Provider business mailing address

391 MYRTLE AVE STE 2
ALBANY NY
12208-3797
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4942
  • Fax: 518-262-5291
Mailing address:
  • Phone: 518-262-4942
  • Fax: 518-262-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number282919-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: