Provider Demographics
NPI:1437118858
Name:LIN, KATHERINE SUE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUE
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 1:121 S PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2673
Mailing Address - Country:US
Mailing Address - Phone:937-376-9731
Mailing Address - Fax:937-376-5521
Practice Address - Street 1:121 S PROGRESS DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2673
Practice Address - Country:US
Practice Address - Phone:937-376-9731
Practice Address - Fax:937-376-5521
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075281L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256259Medicaid
OH4051862Medicare PIN
OHH023690Medicare PIN
OH2256259Medicaid