Provider Demographics
NPI:1346284999
Name:HARRELL, LINDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130 - PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8820 S MERIDIAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6057
Practice Address - Country:US
Practice Address - Phone:317-865-6700
Practice Address - Fax:317-865-6707
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01040457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335010Medicaid
IN100335010Medicaid
INP00887149Medicare PIN
INM400016638Medicare PIN
IN144360AMedicare PIN