Provider Demographics
NPI:1760407712
Name:WEINER, LINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:WEINER
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:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0520
Mailing Address - Country:US
Mailing Address - Phone:808-332-8523
Mailing Address - Fax:808-332-7050
Practice Address - Street 1:4489 PAPALINA RD
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8503
Practice Address - Country:US
Practice Address - Phone:808-332-8523
Practice Address - Fax:808-332-7050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-2938208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2938-01OtherLONGS/MDX
03681601OtherALOHACARE
HI03681601Medicaid
7768488OtherUHA
C97858OtherKAISER
99-0262194OtherHMAA
00A0040525OtherHMSA
99-0262194OtherHMA
99-0262194OtherHMAA
7768488OtherUHA