Provider Demographics
NPI:1033107115
Name:DOLIN, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 GLADES ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4150
Mailing Address - Country:US
Mailing Address - Phone:561-573-3495
Mailing Address - Fax:888-910-3040
Practice Address - Street 1:7777 GLADES ROAD
Practice Address - Street 2:STE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4150
Practice Address - Country:US
Practice Address - Phone:561-573-3495
Practice Address - Fax:888-910-3040
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56018207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11541XOtherMEDICARE PTAN
FL268143900Medicaid
FLP00436796OtherMEDICARE RAILROAD PTAN
FL11541XOtherMEDICARE PTAN
FL11541Medicare ID - Type Unspecified
FL11541XMedicare PIN