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NPI Code Detail

MEDICARE: DIANA MARIE LINDEROTH MD

MEDICARE: DIANA MARIE LINDEROTH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD26022OR
2208000000XPediatrics PhysicianM-2009GU

General Provider Information

NPI Number : 1053495630
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA MARIE LINDEROTH MD
Provider Business Mailing Address
First Line : 2050 PROGRESS WAY
Second Line :
City : WOODBURN
State : OR
Zip : 97071-9764
Country : US
Telephone Number : 503-981-5348
Fax Number : 503-981-0423
Provider Business Practice Location Address
First Line : 2050 PROGRESS WAY
Second Line :
City : WOODBURN
State : OR
Zip : 97071-9764
Country : US
Telephone Number : 503-981-5348
Fax Number : 503-981-0423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 11/08/2016

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Directions to “ DIANA MARIE LINDEROTH MD” Practice Location

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