Provider Demographics
NPI:1942258546
Name:LIN, BRADFORD J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:J
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 1:12265 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:215-698-3730
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-2749
Practice Address - Fax:215-938-3829
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037395E207RC0000X
PAMD-037395-E207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14637960101Medicaid
PA597586OtherMEDICARE TPI GROUP
PACD4829OtherRAILROAD MEDICARE TPI GROUP
PA1007278000OtherMEDICAID TPI GROUP
PACD4829OtherRAILROAD MEDICARE TPI GROUP
F28081Medicare UPIN