Provider Demographics
NPI:1780871186
Name:LIN, PETER T (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 POLLARD RD STE C30
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 POLLARD RD
Practice Address - Street 2:SUITE C30
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1415
Practice Address - Country:US
Practice Address - Phone:408-376-0316
Practice Address - Fax:408-841-7567
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA798912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA156597Medicare UPIN