Provider Demographics
NPI:1629148986
Name:HANNA-TRAD, LINDA J (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:HANNA-TRAD
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 1:214 HIGH SERVICE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5115
Mailing Address - Country:US
Mailing Address - Phone:401-353-7370
Mailing Address - Fax:401-353-4385
Practice Address - Street 1:214 HIGH SERVICE AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5115
Practice Address - Country:US
Practice Address - Phone:401-353-7370
Practice Address - Fax:401-353-4385
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI09017207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI009017OtherTUFTS
RI7004900Medicaid
RI0401886OtherUNITED HEALTH
RI4186OtherNEIGHBORHOOD HEALTH
RI009017OtherTUFTS
G10995Medicare UPIN