Provider Demographics
NPI:1184117111
Name:LIN, VANESSA (DO)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:179 INDEPENDENCE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 INDEPENDENCE RD FL 2
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9207
Practice Address - Country:US
Practice Address - Phone:570-421-3900
Practice Address - Fax:570-476-6108
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2023-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS021159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine