MEDICARE: DR. RICHARD THOMAS LINN JR. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	010603	NY

General Provider Information

NPI Number	:	1972704849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD THOMAS LINN JR. PH.D.

Provider Business Mailing Address
First Line	:	2292 EMERY RD
Second Line	:
City	:	SOUTH WALES
State	:	NY
Zip	:	14139-9704
Country	:	US
Telephone Number	:	716-655-0120
Fax Number	:	716-655-0120

Provider Business Practice Location Address
First Line	:	2292 EMERY RD
Second Line	:
City	:	SOUTH WALES
State	:	NY
Zip	:	14139-9704
Country	:	US
Telephone Number	:	716-655-0120
Fax Number	:	716-655-0120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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