Provider Demographics
NPI:1568527364
Name:WEBER, LINDA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ELAINE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:317 SOUTH MANNING BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-482-5620
Mailing Address - Fax:518-482-4346
Practice Address - Street 1:317 SOUTH MANNING BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-482-5620
Practice Address - Fax:518-482-4346
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00569053Medicaid
NY00569053Medicaid
37933BMedicare ID - Type Unspecified