Basic Information
Provider Information
NPI: 1285891481
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LYNCH
FirstName: DONALD
MiddleName: RAY
NamePrefix: DR.
NameSuffix: JR.
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LYNCH
OtherFirstName: DONALD
OtherMiddleName: RAY
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 5
Mailing Information
Address1: P.O. BOX 636256
Address2: CENTRAL CREDENTIALING
City: CINCINNATI
State: OH
PostalCode: 452636256
CountryCode: US
TelephoneNumber: 5132453104
FaxNumber: 5135855511
Practice Location
Address1: 234 GOODMAN STREET
Address2:  
City: CINCINNATI
State: OH
PostalCode: 45219
CountryCode: US
TelephoneNumber: 5134758521
FaxNumber: 5134757480
Other Information
ProviderEnumerationDate: 05/16/2008
LastUpdateDate: 06/30/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0011X35 127129OHY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


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