Provider Demographics
NPI:1669585170
Name:LYNCH, MELANIE A (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:CELESTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5520 PARK AVE STE 1-500
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-254-3070
Mailing Address - Fax:203-337-8790
Practice Address - Street 1:5520 PARK AVE STE 1-500
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-254-2381
Practice Address - Fax:203-337-8788
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT671222086X0206X
OH35-083052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2695561Medicaid