Provider Demographics
NPI:1770565855
Name:LIN, ANGELA E (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:E
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-1561
Mailing Address - Fax:617-726-1566
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:WRN 801 GENETICS & TERATOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-1742
Practice Address - Fax:617-724-1911
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72236207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA072236OtherTUFTS HEALTH PLAN
MAJ10829OtherBCBS MA
MA3077691Medicaid
MAJ10829OtherBCBS MA
MAJ10829Medicare ID - Type Unspecified