Provider Demographics
NPI:1619279429
Name:STEPHANIE LINDER, M.D., LLC
Entity Type:Organization
Organization Name:STEPHANIE LINDER, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-679-4353
Mailing Address - Street 1:902 AVERILL RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3827
Mailing Address - Country:US
Mailing Address - Phone:410-679-4353
Mailing Address - Fax:
Practice Address - Street 1:902 AVERILL RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3827
Practice Address - Country:US
Practice Address - Phone:410-679-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2014-10-16
Deactivation Date:2013-09-05
Deactivation Code:
Reactivation Date:2014-10-16
Provider Licenses
StateLicense IDTaxonomies
MDD0043909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF69305Medicare UPIN