MEDICARE: DAVID W LYNCH MD

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	208000000X	Pediatrics Physician	010575	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	030224	OTHER	ANTHEM
3	1042474	OTHER	AETNA

General Provider Information

NPI Number	:	1598734253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W LYNCH MD

Provider Business Mailing Address
First Line	:	100 FODEN RD., WEST
Second Line	:	SOUTH 203
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106
Country	:	US
Telephone Number	:	207-828-0361
Fax Number	:	207-874-1483

Provider Business Practice Location Address
First Line	:	84 MARGINAL WAY
Second Line	:	SUITE 1000
City	:	PORTLAND
State	:	ME
Zip	:	04101-2443
Country	:	US
Telephone Number	:	207-774-4092
Fax Number	:	207-523-8596

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	10/29/2010

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Directions to “ DAVID W LYNCH MD” Practice Location

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