Basic Information
| Provider Information | |||||||||
| NPI: | 1104189463 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LIN | ||||||||
| FirstName: | NAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 BURNET AVE ML11006 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364991 | ||||||||
| FaxNumber: | 5136363980 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 BURNET AVE ML11006 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364991 | ||||||||
| FaxNumber: | 5136363980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 07/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT201996 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0402X | 35.130830 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No ID Information.