Provider Demographics
NPI:1679522874
Name:ANTHONY, LINA (MD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:ANDALKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3638 E SOUTHERN AVE STE C108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2563
Mailing Address - Country:US
Mailing Address - Phone:480-834-0771
Mailing Address - Fax:480-834-1136
Practice Address - Street 1:3638 E SOUTHERN AVE STE C108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2563
Practice Address - Country:US
Practice Address - Phone:480-834-0771
Practice Address - Fax:480-834-1136
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37173207RP1001X, 207RC0200X
NJ25MA07790200207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062731Medicaid
AZ307822Medicaid
AZZ148047OtherMEDICARE PTAN MD ANDERSON
NY02815612Medicaid
AZZ78334OtherMEDICARE GROUP
NY02815612Medicaid