Provider Demographics
NPI:1548273501
Name:LIN, ELLEN W (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:W
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WAN-TIN
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 SPURS LANE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-690-0777
Mailing Address - Fax:210-690-0779
Practice Address - Street 1:21 SPURS LANE
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-0777
Practice Address - Fax:210-690-0779
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM01512081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F7360Medicare PIN