Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | D0063996 | MD |
NPI | 1003853169 |
---|---|
Provider Name | Charles Lin |
First Address | Roslyn Heights, NY 11577-1324 |
Second Address | Baltimore, MD 21229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41012190 | (05) | MD |
454MN960 | TRAILBLAZER (01) | MD |