1922098870 NPI number — PENGXIN LIN M.D.

Table of content: PENGXIN LIN M.D. (NPI 1922098870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922098870 NPI number — PENGXIN LIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
PENGXIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922098870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 RANDOLPH RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-2257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-881-6651
Provider Business Mailing Address Fax Number:
301-881-6653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 RANDOLPH ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-881-6651
Provider Business Practice Location Address Fax Number:
301-881-6653
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D0058236 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208U00000X , with the licence number: D0058236 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120631 . This is a "JOHNS HOPKINS HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7870575 . This is a "AETNA-PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8127281 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7691425 . This is a "AETNA STUDENT MC N" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 146804160 . This is a "AMERIGROUP MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K143-0002 . This is a "BC/BS DC AND FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 12-06189 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3543954 . This is a "AETNA--HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 401615700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 618642-02 . This is a "BC/BS MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 653547 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P16571 . This is a "BC/BS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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