Provider Demographics
NPI:1457316093
Name:LIN, LONNIE P (MD)
Entity Type:Individual
Prefix:MS
First Name:LONNIE
Middle Name:P
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2190
Mailing Address - Country:US
Mailing Address - Phone:510-204-0965
Mailing Address - Fax:510-549-0334
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2190
Practice Address - Country:US
Practice Address - Phone:510-204-0965
Practice Address - Fax:510-549-0334
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2003 00375207V00000X
CAA99567207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136F8Medicaid
NC89136F8Medicaid
CA00A995670Medicare PIN
NC2024707Medicare ID - Type Unspecified