Provider Demographics
NPI:1366591554
Name:LYNCH, RONALD (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W. LAKE MARY BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:407-936-1700
Mailing Address - Fax:407-936-1701
Practice Address - Street 1:2500 W. LAKE MARY BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-936-1700
Practice Address - Fax:407-936-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50990207Q00000X
FL207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030428846OtherTAX ID
FL08171OtherBCBS
FL08171Other34826
FL035339600Medicaid
FL216405OtherAMERIGROUP
FL223836OtherSTAYWELL
FL08171Other34826
FL08171SMedicare ID - Type UnspecifiedK4215
FL216405OtherAMERIGROUP
FL035339600Medicaid