Healthcare Provider Details

I. General information

NPI: 1982647350
Provider Name (Legal Business Name): ANDREW KEANE LYNCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 112TH AVE NE SUITE D258
BELLEVUE WA
98004-3752
US

IV. Provider business mailing address

1750 112TH AVE NE SUITE D258
BELLEVUE WA
98004-3752
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-2272
  • Fax: 425-451-1052
Mailing address:
  • Phone: 425-451-2272
  • Fax: 425-451-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60105638
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2006-00628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: