Provider Demographics
NPI:1316300064
Name:LINDA J. HANNA-TRAD, M.D., INC
Entity type:Organization
Organization Name:LINDA J. HANNA-TRAD, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HANNA-TRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-556-1533
Mailing Address - Street 1:185A HIGH SERVICE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5114
Mailing Address - Country:US
Mailing Address - Phone:401-556-1533
Mailing Address - Fax:
Practice Address - Street 1:185A HIGH SERVICE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5114
Practice Address - Country:US
Practice Address - Phone:401-556-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI09017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI009017OtherTUFTS
RI0401886OtherUNITED HEALTH
RI4186OtherNEIGHBORHOOD HEALTH
RI7004900Medicaid
RI007006522OtherMEDICARE
RI7004900Medicaid