Provider Demographics
NPI:1669432779
Name:CROUT WINGARD, LINDA J (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:CROUT WINGARD
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 1:2525 KINARD STREET
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108
Mailing Address - Country:US
Mailing Address - Phone:803-405-0220
Mailing Address - Fax:803-405-0222
Practice Address - Street 1:2525 KINARD STREET
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108
Practice Address - Country:US
Practice Address - Phone:803-405-0220
Practice Address - Fax:803-405-0222
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC129572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3903Medicaid
SCGP3903Medicaid