Provider Demographics
NPI:1114914892
Name:LINSTER, JOHN MARVIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARVIN
Last Name:LINSTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-289-8427
Mailing Address - Fax:704-283-5522
Practice Address - Street 1:1420 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5160
Practice Address - Country:US
Practice Address - Phone:704-289-8427
Practice Address - Fax:704-283-5522
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9800314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00315Medicaid
NC8911500Medicaid
NCF54466Medicare UPIN
SCN00315Medicaid
NC8911500Medicaid