Provider Demographics
NPI:1144263591
Name:LYNN, MATTHEW DAVID (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:LYNN
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 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG628192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G628190Medicaid
CA00G628199Medicare PIN
CAA53706Medicare UPIN
CA00G6281911Medicare PIN
CA00G6281915Medicare PIN
CA00G628195Medicare PIN
CA00G628192Medicare PIN
CA300024668Medicare PIN
CA00G6281913Medicare PIN
CA00G628198Medicare PIN
CA00G628191Medicare PIN
CA00G6281912Medicare PIN
CA00G6281914Medicare PIN
CA00G6281910Medicare PIN
CA00G628193Medicare PIN
CA00G628194Medicare PIN
CA00G628196Medicare PIN
CA00G628197Medicare PIN