Provider Demographics
NPI:1316946254
Name:LIN, ANTHONY C (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4981
Mailing Address - Country:US
Mailing Address - Phone:407-260-6000
Mailing Address - Fax:407-260-2133
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:SUITE 110A
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4981
Practice Address - Country:US
Practice Address - Phone:407-260-6000
Practice Address - Fax:407-260-2133
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263495300Medicaid
FL263495300Medicaid
08125ZMedicare PIN