Basic Information
Provider Information | |||||||||
NPI: | 1891720892 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LYNCH | ||||||||
FirstName: | TIMOTHY | ||||||||
MiddleName: | R. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 141 LONGWATER DRIVE | ||||||||
Address2: |   | ||||||||
City: | NORWELL | ||||||||
State: | MA | ||||||||
PostalCode: | 020619147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7818785200 | ||||||||
FaxNumber: | 7818786750 | ||||||||
Practice Location | |||||||||
Address1: | 143 LONGWATER DRIVE | ||||||||
Address2: |   | ||||||||
City: | NORWELL | ||||||||
State: | MA | ||||||||
PostalCode: | 020619147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7818785200 | ||||||||
FaxNumber: | 7818786750 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2006 | ||||||||
LastUpdateDate: | 01/08/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 71279 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 95986103 | 01 |   | NETWORK HEATLH | OTHER | J10645 | 01 | MA | BCBS | OTHER | 071279 | 01 |   | TUFTS AND TMP | OTHER | 042297845 | 01 |   | UNICARE | OTHER | 4265474 | 01 | MA | AETNA | OTHER | 042297845 | 01 |   | UNITED HEALTH CARE | OTHER | 189170892 | 05 | MA |   | MEDICAID | 3077764 | 05 | MA |   | MEDICAID | 042297845 | 01 |   | TRICARE | OTHER | 042297845 | 01 |   | HCVM/FIRST HEALTH | OTHER | 4391781 | 01 |   | CIGNA | OTHER | AA283358 | 01 |   | HARVARD PILGRIM | OTHER |