Provider Demographics
NPI:1093987364
Name:LINEBERRY, OLENA KOTOVA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLENA
Middle Name:KOTOVA
Last Name:LINEBERRY
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:PO BOX 45680 PHYSICIAN SUPPORT SERVICES
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-7956
Mailing Address - Country:US
Mailing Address - Phone:530-626-2787
Mailing Address - Fax:
Practice Address - Street 1:1004 FOWLER WAY STE 4
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5746
Practice Address - Country:US
Practice Address - Phone:530-626-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129184207RP1001X, 207RC0200X, 207RP1001X
NE6424390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program