Healthcare Provider Details

I. General information

NPI: 1922092659
Provider Name (Legal Business Name): WU JAN LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

763 JOHNSONBURG RD
SAINT MARYS PA
15857-3417
US

IV. Provider business mailing address

761 JOHNSONBURG RD
ST MARYS PA
15857-3483
US

V. Phone/Fax

Practice location:
  • Phone: 814-834-1020
  • Fax: 814-834-1040
Mailing address:
  • Phone: 814-834-1020
  • Fax: 814-834-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD019839E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: