Basic Information
Provider Information
NPI: 1417246729
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LYNCH
FirstName: MATTHEW
MiddleName: DAVID
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2830 VICTORY PKWY
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452061785
CountryCode: US
TelephoneNumber: 5135855504
FaxNumber: 5135855511
Practice Location
Address1: 234 GOODMAN ST
Address2: ML 0781
City: CINCINNATI
State: OH
PostalCode: 45219
CountryCode: US
TelephoneNumber: 5135844505
FaxNumber: 5135840468
Other Information
ProviderEnumerationDate: 04/07/2011
LastUpdateDate: 08/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X57.019741OHN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X35132517OHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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