Provider Demographics
NPI:1922098870
Name:LIN, PENGXIN (MD)
Entity Type:Individual
Prefix:
First Name:PENGXIN
Middle Name:
Last Name:LIN
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 1:4701 RANDOLPH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2257
Mailing Address - Country:US
Mailing Address - Phone:301-881-6651
Mailing Address - Fax:301-881-6653
Practice Address - Street 1:4701 RANDOLPH ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2260
Practice Address - Country:US
Practice Address - Phone:301-881-6651
Practice Address - Fax:301-881-6653
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058236208000000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD120631OtherJOHNS HOPKINS HEALTH CARE
MD7870575OtherAETNA-PPO
MD8127281OtherMAMSI
MD7691425OtherAETNA STUDENT MC N
MD146804160OtherAMERIGROUP MEDICAID
MDK143-0002OtherBC/BS DC AND FEDERAL
MD12-06189OtherUNITED HEALTH CARE
MD3543954OtherAETNA--HMO
MD401615700Medicaid
MD618642-02OtherBC/BS MARYLAND
MD653547OtherNCPPO
MDP16571OtherBC/BS POS
MD401615700Medicaid