Provider Demographics
NPI:1265579924
Name:LIN, ROBERT T (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
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 1:52 WEST SHIRLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-9220
Mailing Address - Fax:540-347-0492
Practice Address - Street 1:555 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3028
Practice Address - Country:US
Practice Address - Phone:540-347-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA460974OtherANTHEM PROVIDER #
VA2116082OtherMAMSI
VA2621480OtherCIGNA PROVIDER #
VA297360OtherSOUTHERN HEALTH PROVIDER
VA7384246OtherAETNA PROVIDER #
VA50820006OtherC AREFIRST PROVIDER #
VA5883563Medicaid
VA460974OtherHEALTHKEEPERS PROVIDER #
VAP00125032Medicare PIN
VA000645W33Medicare PIN
VA7384246OtherAETNA PROVIDER #