Basic Information
| Provider Information | |||||||||
| NPI: | 1750397824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINK | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437259612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404390733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1210 NEAL DR | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437251143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404352350 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 35-094159 | OH | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 000433254O | 05 | GA | MEDICAID | 00433254P | 05 | GA | MEDICAID | 2998716 | 05 | OH | MEDICAID | 52451117-0037 | 01 | GA | BC/BS | OTHER | 000433254Q | 05 | GA | MEDICAID |