Basic Information
| Provider Information | |||||||||
| NPI: | 1215922307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | BRENDAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 LIFELINE RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183607566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704766700 | ||||||||
| FaxNumber: | 5704760124 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 LIFELINE RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183607566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704766700 | ||||||||
| FaxNumber: | 5704760124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | OS006783E | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0011675650003 | 05 | PA | MEDICAID |