Provider Demographics
NPI:1548264823
Name:LYNCH, MARK O (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:O
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4021
Mailing Address - Country:US
Mailing Address - Phone:812-232-1123
Mailing Address - Fax:812-232-1409
Practice Address - Street 1:1818 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4021
Practice Address - Country:US
Practice Address - Phone:812-232-1123
Practice Address - Fax:812-232-1409
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031535208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC15692OtherMEDICARE RAILROAD
IN020032279OtherMEDICARE RAILROAD
IN100226060AMedicaid
IN100251860Medicaid
IN239250Medicare PIN
IN100226060AMedicaid