Healthcare Provider Details

I. General information

NPI: 1902887573
Provider Name (Legal Business Name): LINDA M DINERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LILY FLAGG RD SW SUITE C
HUNTSVILLE AL
35802-3066
US

IV. Provider business mailing address

420 LOWELL DRIVE SUITE 103
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 256-883-1110
  • Fax: 256-883-1114
Mailing address:
  • Phone: 256-535-5940
  • Fax: 256-535-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number24103
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: