Provider Demographics
NPI:1801898457
Name:LIN, KATHRYN RITA (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RITA
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-2266
Mailing Address - Country:US
Mailing Address - Phone:813-782-6064
Mailing Address - Fax:813-782-0984
Practice Address - Street 1:6712 DAIRY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6637
Practice Address - Country:US
Practice Address - Phone:813-782-6064
Practice Address - Fax:813-782-0984
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME48563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044000100Medicaid
FL044000100Medicaid
D50519Medicare UPIN