Basic Information
| Provider Information | |||||||||
| NPI: | 1942258546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12265 TOWNSEND RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191541201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158561010 | ||||||||
| FaxNumber: | 2156983730 | ||||||||
| Practice Location | |||||||||
| Address1: | 1648 HUNTINGDON PIKE | ||||||||
| Address2: | |||||||||
| City: | MEADOWBROOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190468001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159382749 | ||||||||
| FaxNumber: | 2159383829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD037395E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | MD-037395-E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 14637960101 | 05 | PA | MEDICAID | 597586 | 01 | PA | MEDICARE TPI GROUP | OTHER | CD4829 | 01 | PA | RAILROAD MEDICARE TPI GROUP | OTHER | 1007278000 | 01 | PA | MEDICAID TPI GROUP | OTHER |