Healthcare Provider Details

I. General information

NPI: 1013038850
Provider Name (Legal Business Name): RYAN J LYNCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-3488
  • Fax: 814-868-3499
Mailing address:
  • Phone: 814-868-2529
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS013094
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34009241
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS013094
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: