1063505311 NPI number — LIN CHOU MD

Table of content: LIN CHOU MD (NPI 1063505311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063505311 NPI number — LIN CHOU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOU
Provider First Name:
LIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1063505311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-5217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-728-9350
Provider Business Mailing Address Fax Number:
401-728-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-728-9350
Provider Business Practice Location Address Fax Number:
401-728-1320
Provider Enumeration Date:
10/01/2006

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: 207W00000X , with the licence number:  MD10486 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 407996 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2450160 . This is a "AETNA U.S. HEALTHCARE- MASTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 352248 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: LC34245 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000022503 . This is a "BLUE SHIELD OF RHODE ISLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD10486 . This is a "STATE MEDICAL LICENSE #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0800784 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180043198 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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