Provider Demographics
NPI:1356832364
Name:LINDEN CEDRIC FERNANDO, MC, PLLC
Entity Type:Organization
Organization Name:LINDEN CEDRIC FERNANDO, MC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CRENDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-341-2570
Mailing Address - Street 1:2726 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1827
Mailing Address - Country:US
Mailing Address - Phone:423-758-6744
Mailing Address - Fax:423-758-6741
Practice Address - Street 1:2726 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1827
Practice Address - Country:US
Practice Address - Phone:423-758-6744
Practice Address - Fax:423-758-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17808207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty