Provider Demographics
NPI:1710920749
Name:CHIN, LINCOLN (MD)
Entity Type:Individual
Prefix:
First Name:LINCOLN
Middle Name:
Last Name:CHIN
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 1:1650 W ROSEDALE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-336-1181
Mailing Address - Fax:817-336-7817
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-336-1181
Practice Address - Fax:817-336-7817
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF47922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131675402Medicaid
TX00G501Medicare PIN
TX131675402Medicaid