Provider Demographics
NPI:1275895666
Name:HEFFERNAN, LINDA AUGUSTA (MD/PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:AUGUSTA
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:AUGUSTA
Other - Last Name:HEFFERNAN-STROUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD/PHD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:7560 CARPENTER FIRE STATION RD STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9637
Practice Address - Country:US
Practice Address - Phone:919-439-4206
Practice Address - Fax:919-439-9375
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259854207N00000X
NC2016-00343207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology