Provider Demographics
NPI:1417962929
Name:MAERZ, LINDA LORIE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LORIE
Last Name:MAERZ
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 1:330 CEDAR STREET
Mailing Address - Street 2:BB 310 BOARDMAN BUILDING
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520
Mailing Address - Country:US
Mailing Address - Phone:203-785-2572
Mailing Address - Fax:203-785-3950
Practice Address - Street 1:330 CEDAR STREET
Practice Address - Street 2:BB 310 BOARDMAN BUILDING
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-785-2572
Practice Address - Fax:203-785-3950
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16328208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR071105Medicaid
OR071105Medicaid