Provider Demographics
NPI:1063529519
Name:MA, LIN (MD)
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1051 TUOLUMNE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382
Mailing Address - Country:US
Mailing Address - Phone:209-202-3762
Mailing Address - Fax:209-343-2425
Practice Address - Street 1:1051 E. TUOLUMNE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-202-3762
Practice Address - Fax:209-343-2425
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI416822084N0400X
CAA544262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063529519Medicaid
WI32605500Medicaid
BM4700654OtherDEA NUMBER
G18880Medicare UPIN
WI32605500Medicaid