Provider Demographics
NPI:1114943420
Name:LINETTE, GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:LINETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:8TH FLR SOUTH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-615-5858
Mailing Address - Fax:215-349-8144
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-1171
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO103723207RX0202X
PAMD458447207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO014410183Medicaid
IL$$$$$$$$$Medicaid
MO014410183Medicare PIN
MO900003904Medicare PIN