Provider Demographics
NPI:1891726733
Name:ALSTON, LINDA L (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:ALSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3085 W MARKET ST
Mailing Address - Street 2:#102
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3619
Mailing Address - Country:US
Mailing Address - Phone:330-836-0201
Mailing Address - Fax:330-836-9406
Practice Address - Street 1:3085 W MARKET ST
Practice Address - Street 2:#102
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-3619
Practice Address - Country:US
Practice Address - Phone:330-836-0201
Practice Address - Fax:330-836-9406
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033819207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000026192OtherANTHEM BLUE CROSS
OH0242071Medicaid
OH729869OtherBUCKEYE COMM HEALTH
OH729869OtherBUCKEYE COMM HEALTH
OH0242071Medicaid