Provider Demographics
NPI:1992804934
Name:LINETSKY, LIDIA (MD)
Entity type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:
Last Name:LINETSKY
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 1:611 DRUID ROAD EAST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-442-6655
Mailing Address - Fax:727-442-6633
Practice Address - Street 1:611 DRUID ROAD EAST
Practice Address - Street 2:SUITE 302
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-442-6655
Practice Address - Fax:727-442-6633
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00562822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261251800Medicaid
FLA58472Medicare UPIN
A58472Medicare UPIN
08409AMedicare PIN
FL261251800Medicaid