Healthcare Provider Details

I. General information

NPI: 1194706960
Provider Name (Legal Business Name): GREGORY T LYNAM MD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 STONY POINT PKWY SUITE 100
RICHMOND VA
23235-1988
US

IV. Provider business mailing address

8720 STONY POINT PKWY SUITE 100
RICHMOND VA
23235-1988
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-5260
  • Fax: 804-560-4665
Mailing address:
  • Phone: 804-560-5260
  • Fax: 804-560-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101102539
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: