Provider Demographics
NPI:1861607863
Name:LIN, MARK R
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:RENTSONG
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 ALMOND CIR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5116
Mailing Address - Country:US
Mailing Address - Phone:609-897-0465
Mailing Address - Fax:609-897-1397
Practice Address - Street 1:1201 LANGHORNE NEWTOWN RD
Practice Address - Street 2:ST.MARY MEDICAL CENTER
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1201
Practice Address - Country:US
Practice Address - Phone:215-710-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049747-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine