Provider Demographics
NPI:1891993382
Name:LINN, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:LINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4348
Mailing Address - Country:US
Mailing Address - Phone:704-993-2107
Mailing Address - Fax:704-993-2115
Practice Address - Street 1:1328 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4348
Practice Address - Country:US
Practice Address - Phone:704-993-2107
Practice Address - Fax:704-993-2115
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01391208800000X
DCMD040368208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891993382Medicaid
NCP01250564OtherRR MEDICARE
NC1891993382Medicaid
DC064548400Medicare PIN