Provider Demographics
NPI:1851371181
Name:WASSERMAN, LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:WASSERMAN
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 1:1306 CENTURY OAK DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4026
Mailing Address - Country:US
Mailing Address - Phone:407-247-1832
Mailing Address - Fax:
Practice Address - Street 1:5335 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6123
Practice Address - Country:US
Practice Address - Phone:707-263-7725
Practice Address - Fax:707-263-1096
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL199954OtherSTAYWELL
FL102427374756OtherHUMANA
FL6657345OtherCIGNA
FL2834021OtherAETNA
FL201994OtherAMERIGROUP
FL048981600Medicaid
FL14845OtherBLUE CROSS/BLUE SHIELD
FL199954OtherSTAYWELL
FL267539100Medicaid