Provider Demographics
NPI:1568660975
Name:LIN, KIRSTEN (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:DACAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20397 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6133
Mailing Address - Country:US
Mailing Address - Phone:724-772-3300
Mailing Address - Fax:724-772-3360
Practice Address - Street 1:20397 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6133
Practice Address - Country:US
Practice Address - Phone:724-772-3300
Practice Address - Fax:724-772-3360
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023356210002Medicaid
PA164374NHMMedicare PIN