Provider Demographics
NPI:1063505311
Name:CHOU, LIN (MD)
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:CHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5217
Mailing Address - Country:US
Mailing Address - Phone:401-728-9350
Mailing Address - Fax:401-728-1320
Practice Address - Street 1:465 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5217
Practice Address - Country:US
Practice Address - Phone:401-728-9350
Practice Address - Fax:401-728-1320
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
407996OtherBLUE CHIP
2450160OtherAETNA U.S. HEALTHCARE- MASTER
352248OtherTUFTS HEALTH PLAN
RILC34245Medicaid
0000022503OtherBLUE SHIELD OF RHODE ISLAND
RIMD10486OtherSTATE MEDICAL LICENSE #
0800784OtherUNITED HEALTHCARE
180043198OtherRAILROAD MEDICARE
407996OtherBLUE CHIP
189022503Medicare PIN