MEDICARE: KATHLEEN M LYNCH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	N004991	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134179740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M LYNCH DPM

Provider Business Mailing Address
First Line	:	512 TOWNE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066
Country	:	US
Telephone Number	:	315-637-5500
Fax Number	:	315-637-5588

Provider Business Practice Location Address
First Line	:	512 TOWNE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1331
Country	:	US
Telephone Number	:	315-637-5500
Fax Number	:	315-637-5588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/27/2010

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