| Doctor Name: | CHARLES KENNETH LINEHAN |
| NPI Number: | 1356395412 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD 05254 |
| Business Practice Address: | 92659 Highway 202 Astoria, OR - 971038522 |
| Business Phone Number: | 5033253902 |
| Business Fax Number: | 5033253902 |
| Mailing Address: | 92659 Highway 202, ASTORIA |
| State: | OR |
| Postal Code: | 971038522 |
| Phone Number: | 5033253902 |
| Fax Number: | 5033253902 |
| NPI Enumeration Date: | 05/20/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD 05254 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |