Provider Demographics
NPI:1568458966
Name:BARTELL, LINDA DIANA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANA
Last Name:BARTELL
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 1:1221 E SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3374
Mailing Address - Country:US
Mailing Address - Phone:559-450-5777
Mailing Address - Fax:559-450-5687
Practice Address - Street 1:1221 E SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3374
Practice Address - Country:US
Practice Address - Phone:559-450-5777
Practice Address - Fax:559-450-5687
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F98829Medicare UPIN
CAZZZ01252ZMedicare ID - Type Unspecified