Provider Demographics
NPI:1235121922
Name:BRASHEAR, LINDA GERDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GERDA
Last Name:BRASHEAR
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 1239
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6622
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:3515 MASSILLON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6400
Practice Address - Country:US
Practice Address - Phone:330-896-5651
Practice Address - Fax:330-896-5685
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35079750B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2388992Medicaid
OHH63412Medicare UPIN
OHBR4085332Medicare ID - Type Unspecified