Provider Demographics
NPI:1063467611
Name:LINDER, STEPHANIE L (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:LINDER
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 1:902 AVERILL RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3827
Mailing Address - Country:US
Mailing Address - Phone:410-679-4353
Mailing Address - Fax:410-679-0117
Practice Address - Street 1:902 AVERILL RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3827
Practice Address - Country:US
Practice Address - Phone:410-679-4353
Practice Address - Fax:410-679-0117
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110200898OtherRAILROAD MEDICARE
MD529308-08OtherBLUE CROSS BLUE SHIELD
MD110200898OtherRAILROAD MEDICARE