Provider Demographics
NPI:1548361975
Name:PENG, YEN-LIN (MD)
Entity type:Individual
Prefix:
First Name:YEN-LIN
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-341-3321
Practice Address - Street 1:8108B MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9386
Practice Address - Country:US
Practice Address - Phone:910-686-2099
Practice Address - Fax:910-681-3904
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-01239207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127HNOtherBCBS NC
NCP00208595OtherRAILROAD MEDICARE
NC89127HNMedicaid
NC89127HNMedicaid
NC127HNOtherBCBS NC
NC2281067FMedicare PIN
NC2281067EMedicare PIN