Healthcare Provider Details

I. General information

NPI: 1306306972
Provider Name (Legal Business Name): JIERU EGERIA LIN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIERU EGERIA LIN MD, PHD

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N BROADWAY
BALTIMORE MD
21205-1424
US

IV. Provider business mailing address

707 N BROADWAY # 500J
BALTIMORE MD
21205-1888
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-2764
  • Fax:
Mailing address:
  • Phone: 443-923-2764
  • Fax: 443-923-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberD0107711
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number318163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: