Provider Demographics
NPI:1447233416
Name:LINN, GARY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:CHARLES
Last Name:LINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7733
Mailing Address - Country:US
Mailing Address - Phone:732-840-4300
Mailing Address - Fax:732-840-4515
Practice Address - Street 1:446 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7733
Practice Address - Country:US
Practice Address - Phone:732-840-4300
Practice Address - Fax:732-840-4515
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA3227400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1380605Medicaid
NJ06982BSEMedicare ID - Type Unspecified
NJ006982BSEMedicare PIN
D07144Medicare UPIN