Basic Information
Provider Information | |||||||||
NPI: | 1063688117 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LIN | ||||||||
FirstName: | STEPHEN | ||||||||
MiddleName: | HSIANG-HAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 11314 | ||||||||
Address2: |   | ||||||||
City: | BELFAST | ||||||||
State: | ME | ||||||||
PostalCode: | 049154004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7578424481 | ||||||||
FaxNumber: | 7573123135 | ||||||||
Practice Location | |||||||||
Address1: | 113 GAINSBOROUGH SQ | ||||||||
Address2: | SUITE 400 | ||||||||
City: | CHESAPEAKE | ||||||||
State: | VA | ||||||||
PostalCode: | 233201713 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7578424499 | ||||||||
FaxNumber: | 7578424490 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/07/2008 | ||||||||
LastUpdateDate: | 11/20/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/20/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036-119783 | IL | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 0101253581 | VA | Y |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 2014-01211 | NC | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | N0215 | TX | N |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | P00670278 | 01 | TX | MEDICARE RAILROAD | OTHER | 196910701 | 05 | TX |   | MEDICAID | 8AG971 | 01 | TX | BCBSTX | OTHER |