Provider Demographics
NPI:1497066377
Name:LIN, DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2188
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-2188
Mailing Address - Country:US
Mailing Address - Phone:301-392-3330
Mailing Address - Fax:301-392-3950
Practice Address - Street 1:16 N LA PLATA CT
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4283
Practice Address - Country:US
Practice Address - Phone:301-392-3330
Practice Address - Fax:301-392-3950
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006207213E00000X
MD01568213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423429400Medicaid
MD555422ZAQBMedicare PIN
DC380721YRCQMedicare PIN