Provider Demographics
NPI:1245764190
Name:LIN, CONNIE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LIN
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 1:86 MDG
Mailing Address - Street 2:UNIT 3215, RAMSTEIN AB
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RAMSTEIN CLINIC
Practice Address - Street 2:FLUGPLATZ RAMSTEIN GEB 2114
Practice Address - City:RAMSTEIN
Practice Address - State:RAMSTEIN-MIESENBACH
Practice Address - Zip Code:66877
Practice Address - Country:DE
Practice Address - Phone:314-479-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI0101266105208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program