1881696375 NPI number — JAMES C LIN M.D.

Table of content: JAMES C LIN M.D. (NPI 1881696375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881696375 NPI number — JAMES C LIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
JAMES
Provider Middle Name:
C
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:
1881696375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 WASHINGTON ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-6022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-762-0471
Provider Business Mailing Address Fax Number:
781-762-8072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HIGHLAND ST STE 226
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02186-3880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-505-3335
Provider Business Practice Location Address Fax Number:
617-696-7380
Provider Enumeration Date:
08/15/2005

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: 208800000X , with the licence number:  214166 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0198617 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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